US president goes on the offensive following attacks from Republicans who’ve criticised cost of overhaul

President Barack Obama has launched a vigorous campaign to force an overhaul of healthcare through Congress within weeks, and extend affordable medical insurance to all Americans, as the centrepiece of his domestic agenda is threatened by Republicans exploiting divisions in the president’s party and rising public anxiety over the cost of reform.

Obama has accused his opponents of playing the politics of “delay and defeat” as he urges Congress to pass legislation before it goes into recess next month out of concern that if the process drags on late into the year public and congressional support will further erode. The Republicans are now openly attempting to stall the reforms and have said that they see an opportunity to deliver Obama a damaging political defeat.

The president has gone on the offensive by lobbying members of Congress and by appealing directly to the voters in warning that the existing system “works for the insurance and drug companies” while ordinary people face escalating insurance premiums.

“The need for reform is urgent and it is indisputable,” Obama said. “We’ve talked this problem to death, year after year.”

Several bills working their way through Congress would expand health insurance through a new government scheme that would ensure 97% of the population is covered. An estimated 47 million Americans, one in six of the population, is without health coverage. The legislation would subsidise premiums for those on low incomes.

Under a bill before the House of Representatives, the new scheme would in part be paid for with a tax surcharge of between 1% and 5% on high earners. Employers will also be required to provide health benefits to workers or pay the government to do so.

But the process is running in to problems. Six senators, three of them Democrats, have written to Obama urging him to slow passage of the legislation and win the agreement of both parties. One of the senators, Joe Lieberman, described the reforms as “enormous and complicated” and said they shouldn’t be rushed.

Even in the House of Representatives there are signs that doubts are beginning to set in over warnings about cost.

Obama has said he will not sign any healthcare bill that raises the deficit and has argued that reform can be paid for in part by reducing the escalating cost of treatment through the power of the government to negotiate preferential prices with drug companies.

But the president was delivered a significant blow last week when the Congressional Budget Office (CBO) director, Doug Elmendorf, warned that far from saving money, the proposed reforms would add $239bn to the national debt over ten years.

That has proven to be particularly sensitive in the present economic climate with opinion polls showing that public support for Obama on healthcare reform has slumped to less than 50% in part over concerns at the cost.

The president’s position was not helped when a meeting of governors also raised concerns about being landed with the cost of underwriting insurance for the poor.

Then yesterday a hospital Obama has praised as an example of affordable quality healthcare, the Mayo Clinic in Minnesota, came out against his plan.

“The proposed legislation misses the opportunity to help create higher-quality, more affordable healthcare for patients. In fact, it will do the opposite,” the hospital said.

The Republicans have pounced on the concerns. The Huffington Post published what it said is a private Republican party memo outlining strategies to defeat Obama’s proposals through delay. These include a publicity campaign that claims the reforms will deepen the national debt, that the president is endangering healthcare and the economy by experimenting with change, and that the government will take over control of patient care and medicines.

Some Republicans sense Obama is on the back foot. Senator Jim DeMint was recorded in a conference call discussion saying that Republicans should block healthcare reform to undermine the president.

“If we’re able to stop Obama on this, it will be his Waterloo. It will break him,” he said.

The president responded directly to DeMint by accusing some Republicans of playing with an issue as important as healthcare in order to try and regain control of Congress at the next election.

“Think about that. This isn’t about me. This isn’t about politics. This is about a healthcare system that is breaking America’s families, breaking America’s businesses and breaking America’s economy. And we can’t afford the politics of delay and defeat when it comes to healthcare, not this time, not now,” he said.

Obama has also come under criticism for not going to Congress with a detailed plan and instead relying on members to shape the legislation, apparently out of a wish to avoid President Bill Clinton’s mistake in trying to impose healthcare reform and watching it fail.

Obama warned that his opponents are attempting to repeat the strategy.

“They explicitly went after the Clintons, said we’re not going to get this done. So it was a pure political play, a show of strength by the Republicans that helped them regain the House. I think there are folks who think that we should try to dust off that old playbook,” he said.