Obama cheered and heckled
US President Barack Obama has made one of the most important speeches of his presidency, as he faced Congress over his plans for healthcare reform.
Mr Obama said that failure to introduce reform had led the country to breaking point and it was now time to act.
He said he planned to improve health insurance for those who have it and to create an insurance exchange to extend cover to those who do not.
Republicans said Mr Obama's plans would make healthcare much more expensive.
Mr Obama told Congress that the US was the only developed country that allowed millions of its people to endure the hardship of going without healthcare.
 | MARDELL BLOG   It seemed to go down pretty well in the chamber, but it's how Americans receive it over the next few hours and days that really counts  Mark Mardell BBC North America editor  |
"Everyone understands the extraordinary hardships that are placed on the uninsured, who live every day just one accident or illness away from bankruptcy," he said.
"These are not primarily people on welfare. These are middle-class Americans."
But Mr Obama said the current system did not serve well those Americans who do have health insurance either.
"Those who do have insurance have never had less security and stability than they do today.
"More and more Americans worry that if you move, lose your job, or change your job, you'll lose your health insurance too."
He said the US spent one-and-a-half times more on health insurance than any other country but Americans were no healthier than other people.
Heckled
Mr Obama set out details of his plan to reform the system.
 One Republican shouted: "You lie" at Barack Obama during the speech |
He said that nothing in his proposal would require Americans who already have health insurance to change their coverage or doctor.
But he said he would make the insurance work better for individuals by prohibiting insurers from dropping coverage for sick patients or by capping it.
He would also require insurers to cover the cost of routine check-ups and preventative care.
For the millions of uninsured Americans, he said he would create an insurance exchange - a market place where individuals and small business will be able to shop for health insurance at competitive prices.
Mr Obama said a public insurance option could help keep the private health insurance companies honest and competitive.
But he said it would not be subsidised by the government, so would not create unfair competition for the private sector.
He added that the public option was only a means to an end, and he remained open to other ideas if they had the same effect.
| HEALTHCARE IN THE US 46 million uninsured, 25 million under-insured Healthcare costs represent 16% of GDP, almost twice OECD average Reform plans would require all Americans to get insurance Some propose public insurance option to compete with private insurers |
When Mr Obama said illegal immigrants would not benefit from his plan, the Republican ranks showed signs of near mutiny, says the BBC's Jonathan Beale in Washington.
One Republican representative shouted: "You lie", and the president paused briefly.
In the official Republican response to Mr Obama's speech, Representative Charles Boustany, a heart surgeon, urged a fresh start on "a commonsense, bipartisan plan".
He added: "Replacing your family's current healthcare with government-run healthcare is not the answer. In fact, it'll make healthcare much more expensive."
Our correspondent says Mr Obama was clearly not looking for right-wing Republican support - he knows he will not get it.
He says the speech was another strong performance from Mr Obama and an attempt to turn the tide in the healthcare debate.
But our correspondent adds the speech may have also come too late as positions are already entrenched and some of Mr Obama's supporters wonder why he did not do this months ago.
Healthcare reform has been the central issue of his change agenda but has divided both the US public and the country's political establishment.
President Obama said that Congress agreed on about 80% of the reforms that are needed.
But he said months of partisan bickering had only hardened the disdain many Americans have towards their own government.
He is facing almost unanimous opposition from Republicans, who are uneasy about the idea of government-run healthcare and who have accused Mr Obama of attempting to introduce a "socialist" policy.
There are, in theory, enough Democrats in Congress to approve the changes.
But in practice, the party is deeply divided between those that want a publicly-run insurance scheme and those alarmed by the borrowing necessary to fund it.
The complaints about Republicans at the end also didn't sound, to me, like they'll play well. Right now, more voters are on their side than yours. Don't tell them they're gullible dupes, and/or mean-spirited obstructionists. 
The Atlantic Monthly's Megan McArdle has some advice for the president.
The majority of the speech was proddingly practical, in a dutiful debater kind of way... But then, at the end, came the rousing defense of liberalism I was waiting for. For a speech in which he was trying to forge a consensus this was a brave and risky move. Hanna Rosin, of DoubleX, was heartened by Mr Obama's finale.
[It] was nearly an hour of snake-oil salesmanship, promises that cannot possibly be kept, and false invocations of bipartisan civility even as he was trying to deliver partisan roundhouses of his own. John Podhoretz, of Commentary magazine, thought the speech was too partisan.
If Obama hasn't created the perfect plan, he's created something arguably more impressive: a plan that actually might pass. That plan might not do enough to change the system, and it may not spend enough to protect everybody, but there is plenty in the proposal that will better the lives, health coverage, and financial security for millions of real people. The Washington Post's Ezra Klein applauds the president's pragmatism.
Even though I didn't think coming in that he had to move public opinion, he may have actually done that. But if nothing else, he's set the stage for positive action in Congress, laid down the markers he needed to lay down, and in general, regained some serious momentum for health care reform. The New Republic's Ed Kilgore says the president regained momentum.
Taken together I thought President Obama did a solid job laying out the essential elements of his reform, rebuking the liars and laying out some beginnings of an elevating vision of just what this whole effort is about. Just what the effect will be, I find it difficult to predict. Talking Points Memo's Josh Marshall thinks it was a solid job.
Never has a president been warped by Washington quicker. At times tonight, Obama sounded like an embattled second-termer with a 35% approval rating. What percentage of his speech was spent lashing out at his enemies, real and imagined?... This isn't how confident leaders speak. These are the complaints of a man on his way to bitterness. So soon? The Daily Beast's Tucker Carlson says the president sounded bitter.
The problem for Democrats is they are scaring voters by proposing a takeover of healthcare that spends too much money, creates too much debt, gives Washington too much power, and takes too much decision-making away from doctors and patients… the prospect of their own political future may yet concentrate many Democratic minds in Congress. Karl Rove, for the The Wall Street Journal, says Obama's plan could backfire for Democrats.
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