It was a speech that was very important to hear from the president. He tackled things head on, clear, forcefully.

WASHINGTON — President Barack Obama confronted a critical Congress and a skeptical nation on Wednesday, decrying the “scare tactics” of his opponents and presenting his most forceful case yet for a sweeping health care overhaul that has eluded Washington for generations.

In blunt language before a rare joint session of Congress, Obama vowed that he would “not waste time” with those who have made a political calculation to oppose him, but left the door open to working with Republicans to cut health costs and expand coverage to millions of Americans.

“The time for bickering is over,” the president declared. “The time for games has passed. Now is the season for action.”

The president was greeted by booming applause from Democrats and polite handshakes from Republicans. But the political challenge at hand soon became clear as several Republican lawmakers heckled Obama when he dismissed the notion that so-called death panels would deny care to the elderly.

“It is a lie, plain and simple,” Obama declared.

After Obama said it was not true that the Democrats were proposing to provide health coverage to illegal immigrants, Rep. Joe Wilson of South Carolina yelled, “You lie!”

The 47-minute speech was an effort by Obama to regain his political footing on health care, his highest legislative priority. He insisted throughout that he had not closed the door on reaching a bipartisan compromise. He gave a nod to Sen. John McCain, R-Ariz., and embraced his proposal to create a high-risk pool to help cover people with pre-existing conditions against catastrophic expenses.

And, with the widow of Sen. Ted Kennedy sitting in the House gallery, the president appealed to the nation’s conscience, reading a letter Kennedy had written in May with instructions that it be delivered to the president upon his death. In it, Kennedy wrote that health care was “above all a moral issue; at stake are not just the details of policy, but fundamental principles of social justice and the character of our country.”

The speech came after a rocky August for the White House, in which many lawmakers held public meetings that deteriorated into shouting matches over health care.

After months of insisting he would leave the specifics to lawmakers, Obama used the speech to present his most detailed outline yet of a plan he said would provide “security and stability” to those who have insurance and cover those who do not, all without adding to the federal deficit.

The president placed a price tag on the plan of about $900 billion over 10 years, which he said was “less than we have spent on the Iraq and Afghanistan wars.” But he devoted much of his address to making the case for why such a plan is necessary, and sought to reassure the elderly and the Americans who already have insurance that they would not be worse off.

As expected, Obama repeated his support for a government insurance plan to compete with the private sector, though he said he would consider alternatives to the “public option.”

He sketched out a vision for a plan in which it would be illegal for insurers to drop sick people or deny them coverage for pre-existing conditions, and in which every American would be required to carry health coverage, just as drivers must carry auto insurance.

Obama did embrace some fresh proposals. He announced a new initiative to create pilot projects aimed at curbing medical malpractice lawsuits, a cause important to physicians and Republicans.

He endorsed a plan, contained in a draft proposal being circulated by Sen. Max Baucus, D-Mont., the chairman of the Senate Finance Committee, to help pay for expanding coverage by taxing insurance companies that offer expensive, so-called gold-plated insurance plans.

And, seeking to reassure those who worry he will run up the federal deficit, Obama promised to include a provision that “requires us to come forward with more spending cuts” if the savings he envisions do not materialize.

In embracing McCain and the malpractice projects, the White House appeared to be seeking to lay the groundwork for an argument that the final bill would be bipartisan not because it garners Republican votes but because it contains Republican ideas. That is the same argument Obama used when the economic recovery package passed with just three Republican votes.

Republicans seemed primed for a fight; many, like Sen. Charles Grassley, R-Iowa, who has been deeply involved in health negotiations, released statements about the speech before it began. Grassley called on Obama to “start building the kind of legislation that could win the support of 70 to 80 senators” — a goal Grassley said could not be achieved if the bill contained a new government plan.

In the Republican response, Rep. Charles Boustany Jr. of Louisiana, a heart surgeon, agreed that the health care system needed an overhaul. But he urged the president to start anew, focusing on a “common-sense, bipartisan plan.”

An hour after the speech, Wilson, the heckler, issued an apology for his outburst.

While Obama was addressing lawmakers inside the ornate House chamber, the much more important audience was outside Washington: the 180 million Americans who already have health insurance and who remain skeptical that Obama’s plan will change things for the better. Inside the chamber, the president drew laughter when he said, “there remain some significant details to be ironed out.”

Disapproval on health care reform rises

WASHINGTON — Public disapproval of President Barack Obama’s handling of health care has leaped to 52 percent, according to Associated Press-GfK poll that underscores the country’s glowering mood as the White House made a renewed pitch for an overhaul.

Just 42 percent approve of the president’s work on the high-profile health issue. The survey was released Wednesday before his nationally televised effort to persuade Congress and voters to back his drive to reshape the nation’s $2.5 trillion-a-year medical system.

Spotlighting how Obama lost ground this summer, his latest approval figures on health were essentially reversed since July, when 50 percent approved of his health effort and just 43 percent disapproved.

— The Associated Press