WASHINGTON — Spurred on by President Obama and an array of businesses, medical providers and consumers clamoring for change, congressional Democrats have begun to lay out specific plans for overhauling the nation's healthcare system -- proposing changes that would affect almost every American, old or young, sick or well, rich, poor or middle-class.
Despite a looming brawl over key details, the Democratic majority is expected to pass a bill that will make ordinary Americans the ultimate stakeholders who must live with the system, adjust to changes and -- one way or another -- absorb the costs.
For laid-off autoworkers, there could be a new guarantee that they won't lose their family health insurance. A patient with heart disease could receive more advanced treatment to avoid hospitalization. Small shop owners could get help figuring out coverage for employees. An overweight teenager might find a new slim-down program at school.
And for some Americans, especially the affluent and those with traditional job-based medical insurance, there could be new or higher taxes.
After months of spadework and consultation with the interested parties, lawmakers begin the most sweeping healthcare debate in a generation with broad agreement on the need to control costs, improve the care Americans receive and expand coverage to nearly everyone.
But shadowing the debate, which is expected to dominate Washington's summer and extend into the fall, are the same vexing controversies that have derailed almost all previous efforts to reshape the U.S. healthcare system.
There is still no consensus, for example, about how large a role the federal government should play. Nor is there agreement on who should bear the cost, which could surpass $1.5 trillion over the next decade.
Obama's proposals include higher taxes for the wealthiest Americans. But that idea has generated widespread opposition in Congress.
Other financing schemes may be just as unpopular, such as taxing employer-provided health benefits or putting new levies on sugary beverages to raise revenue and encourage healthier behavior.
The first concrete legislation emerged Tuesday as Sen. Edward M. Kennedy (D-Mass.) filed a mammoth bill that, among other things, outlines a dizzying new government regulatory structure to ensure that every American gets health insurance.
