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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.

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

He endorsed a plan, contained in a draft proposal being circulated by Senator Max Baucus, the Montana Democrat who is 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, Mr. 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 Mr. 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 Mr. Obama used when the economic recovery package passed with just three Republican votes.

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

More Articles in US » A version of this article appeared in print on September 10, 2009, on page A1 of the New York edition.

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