Democrats on Thursday laid out an ambitious schedule for extending health care coverage to all Americans that would have the House and Senate pass separate bills by the end of summer, and deliver a final version to President Obama in time to meet his end-of-year deadline.
Mr. Obama set the year-end goal at a White House summit Thursday attended by lawmakers, health care providers, insurers and other stakeholders in the process.
"The productive, energetic discussion at today's White House summit on health care reform set just the right tone for the national conversation on fixing our broken health care system," said Senate Finance Committee Chairman Max Baucus, Montana Democrat, who will have considerable influence over drafting health care legislation.
Mr. Baucus and the committee's ranking Republican, Sen. Charles E. Grassley of Iowa, said they aim to reach an agreement within their panel in June, with the goal of having the bill to the Senate floor for debate and passage by July.
While the Senate is expected to take the lead in writing the legislation, a major role also will go to Rep. Henry A. Waxman, California Democrat and House Energy and Commerce Committee chairman. House Majority Leader Steny H. Hoyer, Maryland Democrat, said he hopes to have a House version finished before Congress recesses in early August.
That would leave the fall for negotiations between the two chambers on a final compromise bill.
Mr. Obama said he has "some pretty strong ideas" about what the plan should look like, and said the White House will provide "some guideposts and guidelines about what we think we can afford to do, how we think it's best to do it."
Both Democrats and Republicans urged the Obama administration not to bypass Congress in its quest to deliver on one of the president's most ambitious and high-stakes promises to the electorate. The Clinton administration wrote a detailed bill in secret in 1993 and then presented it to Congress - a reason often cited for their proposal's failure.
Donna Shalala, President Clinton's secretary of health and human services, told National Economic Council Director Lawrence H. Summers during one of the summit's small group discussions: "Don't write a bill at the White House."
In another "breakout session," Rep. Howard P. "Buck" McKeon, California Republican, looked at Zeke Emanuel, a senior White House health care policy adviser, and said, "I hope the bill isn't already written."
"I can assure you it's not," said Mr. Emanuel, who is the elder brother of White House Chief of Staff Rahm Emanuel.
Mr. Obama began the four-hour summit - which was almost identical in form to last week's meeting on fiscal responsibility - by making clear that rising health care costs, not unfunded entitlements or exploding levels of government spending, is his biggest economic concern.
"By a wide margin, the biggest threat to our nation's balance sheet is the skyrocketing cost of health care," he said.
Although he repeated the familiar line that health care for all is a "moral imperative," he cautioned "liberal bleeding hearts" that "if we don't address costs, I don't care how heartfelt our efforts are, we will not get this done."
"We will run out of money," he said.
Republicans were worried about the prospect of a government-run system, even if it wasn't mandatory.
Though there was ample talk of bipartisanship and plenty of praise for the president's initiative in bringing everyone involved in health care together to discuss the problem, this issue of government-run care was one of the major fault lines exposed during the day's events.
Mr. Obama said that under his plan, "if somebody has insurance that they like, they should be able to keep that insurance. If they have a doctor that they like, they should be able to keep that doctor," and they would pay less for this care.
Roger Hickey, co-director of the Campaign for America's Future, praised Mr. Obama for pursuing "a public health insurance option." He called it "key to expanding coverage, controlling costs, and improving quality in health care."
"The president's plan says that people will have the choice to keep the health insurance they have or they can enroll in the new public plan or an approved private plan," Mr. Hickey said.
But Republicans consider this an interim step toward universal government-run care.
Mr. Grassley, during a question-and-answer session with Mr. Obama in the White House East Room after the breakout sessions, expressed a concern felt by many Republicans.
"There's a lot of us that feel that the public option, that the government is an unfair competitor, and that we're going to get an awful lot of crowd-out. And we have to keep what we have now strong and make it stronger," Mr. Grassley said.
Senate Minority Leader Mitch McConnell of Kentucky and other leading Republican senators sent a letter to the president Wednesday laying out their opposition in some detail.
"Washington-run programs undermine market-based competition through their ability to impose price controls and shift costs to other purchasers. Forcing free market plans to compete with these government-run programs would create an unlevel playing field and inevitably doom true competition," the letter said.
"Ultimately, we would be left with a single government-run program controlling all of the market. This would take health care decisions out of the hands of doctors and patients and place them in the hands of another Washington bureaucracy."
Rep. Roy Blunt, Missouri Republican, who is chairman of a Republican health care solutions working group, said in private conversation within earshot of a Washington Times reporter that the Obama administration appears committed to a government-run option for those who want to use it.
"I'm not sure how we get them to back off that," he said.
In response to Mr. Grassley's question, Mr. Obama said the thinking behind a public option is that it "gives consumers more choices and it helps ... keep the private sector honest."
But he said he understood a fear that "private insurance plans might end up feeling overwhelmed," and promised to "pay attention" to this as the process goes forward.
While Mr. Baucus in recent months has been laying much of the groundwork in Congress on molding a health care package, Sen. Edward M. Kennedy, chairman of the Senate Health, Education, Labor and Pensions Committee, also continues to play a crucial role. The Massachusetts Democrat returned to Washington on Thursday after spending several weeks in Florida undergoing treatment for brain cancer.
A senior Democratic aide, speaking on the condition of anonymity because of the sensitivity of the matter, said Mr. Baucus also intends for his committee to help shape the legislation.
Mr. Kennedy walked into the White House East Room for the summit's final session with the president, and received a sustained standing ovation from the roughly 150 meeting attendees.
"I'm looking forward to being a foot soldier in this undertaking and this time we will not fail," Mr. Kennedy said, drawing more loud cheers.
c Stephen Dinan contributed to this report.