In his second speech before a joint session of Congress, Obama outlined what he wants in any legislation that reaches his desk, and stressed the importance of passing reform legislation now.
He said he will not sign legislation that does not meet three basic goals: provide more security and stability for people with health insurance, provide insurance for those who don't have any and slow the growth of healthcare costs for families, businesses and governments. Healthcare reform, estimated to cost $900 billion over 10 years, must not add to the deficit, he said.
The government-run public health insurance option, anathema to Republicans and conservative Democrats, is his preference, 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," Obama said. "And to my Republican friends, 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 recognized variants of a public option have been included in several proposals in Congress, saying they were "constructive ideas" worth exploring.
"But I will not back down on the basic principle that if Americans can't find affordable coverage, we will provide you with a choice," Obama said to loud applause. "And I will make sure that no government bureaucrat or insurance company bureaucrat gets between you and the care that you need."
Obama did not mention a deadline during his 46-minute speech, but recent polls indicate voters will factor in healthcare-related issues when they go to the polls in 2010.
"Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy," Obama told lawmakers and other Washington dignitaries. "These are not primarily people on welfare. These are middle-class Americans."
Some can't get insurance through their work, he said. Others are self-employed and can't afford coverage. Still others are willing to pay but are still denied insurance because of "previous illnesses or conditions that insurance companies decide are too risky or expensive to cover," he said.
Until now, Obama had outlined broad goals for healthcare reform while letting Congress work out the details. Four of five House and Senate committees have passed their versions of healthcare legislation, and a fifth committee will take up the measure during the next two weeks.
During the August recess, opponents of the Democratic measures blanketed town hall meetings across the country, challenging congressional members during the meetings and frequently becoming disruptive.
Obama called claims of "death panels" and coverage for illegal immigrants "a lie" and "false."
Debating healthcare reform is difficult, Obama said, adding he understood the "politically safe move would be to kick the can further down the road."
"But that's not what the moment calls for. That's not what we came here to do," Obama said in closing. "We did not come to fear the future. We came here to shape it. ... I still believe we can do great things, and that here and now we will meet history's test."