White House continues to slam insurers

St. Charles, Missouri (CNN) -- President Obama took his increasingly populist health care overhaul pitch to the political battleground state of Missouri Wednesday, turning up the heat on private health insurers in a speech.

"What we're proposing is a common-sense approach to protecting you from insurance company abuses, and saving you money," said Obama, his shirtsleeves rolled up in the 75-degree heat. "That's the proposal and it's paid for. I believe Congress owes the American people a final up-or-down vote on health care reform."

He added, "The time for talk is over. It's time to vote."

Obama said many of the changes would be paid for by cutting waste in health care, which he said is estimated to have cost taxpayers almost $100 billion last year.

He likened the national debate about proposed changes to the current system to previous debates that swirled around the topic, including the passage of Medicare in 1965, and before.

"We've been debating it for 70 years," he said.

Obama rejected the suggestion from his opponents that the Democrats scrap the current plan and start over. "Let me tell you something," he said. "The insurance industry is not starting over. They just announced a 39 percent rate increase in California. And a rate increase of up to 60 percent right across the border in my own state of Illinois. Sixty percent in one year. That's the future if we fail to act."

Obama said the changes in the Democrats' bill would result this year in people with pre-existing conditions being able to buy health insurance, would ban insurance companies from denying coverage to children, would ban the industry from dropping coverage when people get sick and would impose a government review on proposed increases in premiums.

It would also create a marketplace where small businesses can get better deals for their employees by including them in large pools of people, he said. Finally, it would lower cost by cutting waste, he said, estimating the bill's price at $100 billion per year.

"That's real money," he said, "But most of that money comes from the nearly $2.5 trillion a year that Americans already spend on health care that we're not spending well."

Obama then addressed his critics, who have likened his proposal to a government takeover of health care. "There is no government takeover, unless you consider reining in insurance companies a government takeover," he said. "And I think that's the right thing to do."

A spokesman for industry lobbying group America's Health Insurance Plans, who did not hear the speech Wednesday, said he has otherwise been unimpressed with Obama's rhetoric.

"Vilifying the insurance industry isn't going to make health insurance more affordable," Robert Zirkelbach said. "The focus needs to be on addressing the underlying health care costs."

But Uwe Reinhardt, a health economist at Princeton University, suggested that Obama's anti-industry comments are part of a strange Kabuki-like dance with health insurers that is intended to build popular support for a bill that insurance industry executives actually want.

"They're going to get 30 million more customers equipped with government subsidies to the tune of $100 billion a year," Reinhardt said. "Their whole book of business now is $800 billion and shrinking, and $100 billion is a sizable extra."

Reinhardt said his suspicions were raised when the industry failed to mount a robust campaign opposing the bill and then hiked premiums in the middle of the debate.

"They are not this dumb," he said. "The industry knows they're going to get a whole lot of extra customers."

The anti-insurance rhetoric that followed those rate hikes "deflected the public from being angry about this and into being angry at the insurance industry again," he said. "This bill purports to tame the industry when, in fact, it makes it richer."

Reinhardt added, "These guys don't care if they're regulated. They know only one thing: It's the bottom line."

Earlier in the day, Obama dispatched Health and Human Services Secretary Kathleen Sebelius to address the annual conference of the group.

"You have a choice," Sebelius said. "You can choose to continue your opposition to reform ... [or] you can choose to take the millions of dollars you have stored away for your next round of ads to kill meaningful reform and use them to start giving Americans some relief from their skyrocketing premiums."

More than 1,000 protesters, including representatives of organized labor, marched through downtown Washington on Tuesday before stopping in front of the Ritz Carlton, site of the conference.

The marchers were led by, among others, former Vermont Gov. Howard Dean, a prominent backer of overhaul legislation.

The health care debate is "about one thing: Are you for the insurance companies or are you for the American people?" Dean asked.

The increasingly sharp rhetoric from the administration and elsewhere is designed both to bolster sagging health care overhaul poll numbers and to intensify pressure on wavering congressional Democrats.

Obama has called for a final up-or-down vote in Congress within the next few weeks. No Republicans are expected to vote for the package.

"Democrat leaders aren't listening to the American people," House Minority Leader John Boehner, R-Ohio, said Wednesday morning. They want to "shove this government takeover of the health care system down the throats of the American people," he said.

Only 25 percent of Americans believe that Congress should pass a health care bill similar to one that Democratic leaders have been working on for the past year, according to a February 12-15 CNN/Opinion Research Corp. poll. But the survey also noted that Americans overwhelmingly approve of many of the bill's specific provisions.

GOP leaders are livid over the Democratic strategy for passing an overhaul bill.

If the House approves the Senate version of the bill, according to Democratic sources, a separate package of changes designed in part to make the overall measure more palatable to House liberals would then be approved by both chambers, getting through the Senate under a legislative maneuver known as reconciliation. Bills passed under reconciliation require only a bare Senate majority of 51 votes.

Senate Democrats lost their filibuster-proof 60-seat supermajority with the election in January of Republican Sen. Scott Brown to the Massachusetts seat formerly held by the late Democratic Sen. Ted Kennedy.

Liberal House Democrats contend, among other things, that the Senate bill does not include an adequate level of subsidies to help middle- and lower-income families purchase coverage. They also object to the Senate's proposed tax on expensive insurance plans.

Separately, a handful of socially conservative House Democrats argue that the Senate plan doesn't do enough to ensure that taxpayer funds are not used to fund abortions.

Republicans, meanwhile, contend that reconciliation, which is limited to provisions pertaining to the budget, was never meant to facilitate the passage of a sweeping measure along the lines of the health care bill.

Four Senate Republicans who previously served in the House held a news conference Wednesday to warn nervous House Democrats that there is no guarantee the reconciliation strategy will succeed.

A unified Senate GOP caucus will fight to prevent changes promised by the Democratic leadership, they said.

House Democrats "better think long and hard" about voting for the Senate plan if they don't like it, said Sen. John Thune, R-South Dakota. "If you vote for the Senate-passed bill, you own the Senate-passed bill."

If the House passes the Senate bill, "the Senate bill will become law," said Sen. Jim DeMint, R-South Carolina. "We're here to guarantee" the measure won't be changed by the Senate.

Sen. Roger Wicker, R-Mississippi, predicted such a turn of events would be politically catastrophic for the Democrats.

If Senate bill passes, it will be "the paramount issue that will see a lot of [Democrats] going home for good after the November elections," he said.