President Barack Obama sought to reframe the contentious debate over health care on Wednesday, asking a critical Congress and a skeptical nation to reach consensus on legislation to expand coverage to millions of Americans and lower costs through a sweeping overhaul that has eluded lawmakers for generations. 'I am not the first president to take up this cause, but I am determined to be the last,' Obama told a joint session of Congress, adding, 'Our collective failure to meet this challenge -- year after year, decade after decade -- has led us to a breaking point.' The speech was an effort by Obama to regain his political footing on health care, the centerpiece of his domestic agenda. After months of insisting he would leave the details to lawmakers, he presented 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 Americans who already have insurance that it would not take something from them. In forceful, direct language, often punctuated by applause, Obama decried his opponents' 'scare tactics' and appealed to the conscience of the nation. With the widow of Sen. Edward M. Kennedy sitting in the House gallery, he read a letter Kennedy had written him, in which he said that health care is '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.' Many of the ideas Obama outlined were not new. He reiterated his support for a 'public option,' a government-backed insurance plan to compete with the private sector, while saying he would consider alternatives. He said his plan would make it illegal for insurance companies to deny coverage to people with pre-existing conditions or drop people who are sick. He proposed that all Americans be required to carry health insurance, in much the same way drivers are required to carry auto insurance. But Obama did embrace some fresh proposals. He announced a new initiative to create pilot projects aimed at curbing medical malpractice lawsuits -- a cause that is important to physicians and Republicans. He adopted an idea put forth by Sen. John McCain, his Republican rival in the 2008 presidential race, for high-risk insurance pools to cover those with pre-existing conditions -- and praised McCain by name in the speech. The White House appeared to be seeking to lay the groundwork for an argument that the final bill will be bipartisan -- not because it garners Republican votes, but because it contains Republican ideas. That is the same argument the Obama administration used early this year, when the president's economic recovery package passed with just three Republican votes. Republicans seemed primed for a fight. Many, like Sen. Charles E. Grassley, R-Iowa, who has been deeply involved in health negotiations, released statements about the speech even 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 that Grassley said could not be achieved if the bill contained a new government plan. The president also 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. The speech was the president's second address before a joint session of Congress. But the political backdrop on Wednesday was far different than Obama's appearance in the House chamber on the 36th day of his term, when an optimistic wave of momentum was at his back and his Republican rivals were dispirited and in disarray. 'What we have also seen in these last months is the same partisan spectacle that only hardens the disdain many Americans have toward their own government. Instead of honest debate, we have seen scare tactics,' Obama said. 'Some have dug into unyielding ideological camps that offer no hope of compromise. Too many have used this as an opportunity to score short-term political points, even if it robs the country of our opportunity to solve a long-term challenge.' He added, 'And out of this blizzard of charges and counter-charges, confusion has reigned.' 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.' Obama was greeted by booming applause from Democrats and polite handshakes from Republicans when he entered the House chamber shortly after 8 p.m. His challenge quickly became clear as heckling erupted from Republican lawmakers, several of whom waved signs in the air. A chorus of 'boos' arose as the president dismissed so-called death panels as 'a lie -- plain and simple.' 'You lie,' one Republican lawmaker yelled back at the president. Obama paused for a moment, then kept going. But he also made clear in his speech that he would have little tolerance for Republicans who were determined to defeat him. 'I will not waste time,' he said, 'with those who have made the calculation that it's better politics to kill this plan than improve it.' For Obama, the speech was a go-for-broke moment; there is no more dramatic venue for a president than an address to a joint session to Congress. For many Democrats, the speech evoked memories of a similar health care address by President Bill Clinton, 16 years ago this month. Clinton called for 'security, simplicity, savings, choice, quality and responsibility' -- the same broad themes Obama evoked Wednesday night. 