A Minnesota medical student and a health policy expert for Mayo Clinic are part of President Barack Obama’s audience for his health care speech to Congress.

The University of Minnesota’s Peter Olsen and Jeffrey Korsmo of Mayo’s Health Policy Center were due in Washington tonight for the speech. The address to lawmakers is part of Obama’s attempt to dislodge stalled health care insurance legislation.

The broadcast of his speech airs on television at 7 p.m.

Olsen is a guest of Minnesota Sen. Amy Klobuchar. He spoke up during a recent roundtable she held to stress the need for more primary care physicians, particularly in rural areas.

Korsmo was invited by Democratic Rep. Tim Walz. Mayo has been cited in the health debate for offering high-quality and low-cost medical care.

Policy landmines abound

WASHINGTON (AP) — Harry Reid could hardly believe his ears.

The Senate majority leader was in Denver for a mid-August Democratic conference when he heard one of Congress’ pivotal negotiators on health care trashing a bill on that very subject.

“You have every right to fear,” Republican Sen. Charles Grassley told a raucous citizens’ forum in Iowa that day. “We should not have a government program that determines you’re going to pull the plug on Grandma.”

Grassley’s stunning comments made Reid second-guess a decision he and President Barack Obama had reluctantly made months earlier: to give six senators from small states, the so-called Gang of Six, the time and prominence to fashion a bipartisan bill on overhauling the health care system.

In retrospect, it was just one of several risks, missed opportunities and dubious decisions that have forced Obama to schedule a high-stakes address to Congress on Wednesday night in hopes of salvaging his top domestic priority.

A team of Associated Press reporters, interviewing dozens of key players, identified several crucial moments and decisions that brought the health care saga to this point.

The first big blow to Obama’s health care agenda came from a bearded, bespectacled Harvard University-trained economist with a background in the Clinton administration.

Douglas Elmendorf, director of the nonpartisan Congressional Budget Office, sat before the Senate Budget Committee on July 16. Chairman Kent Conrad, D-N.D., cut to the chase: Would newly released House bills curb federal health care costs?

Nope, Elmendorf said. “On the contrary,” he said, “the legislation significantly expands the federal responsibility for health care costs.”

Kaboom.

Republicans pounced. House GOP leader John Boehner of Ohio said Elmendorf “confirmed that the Democrats’ government-run plan will make health care more costly than ever.”

Obama later said Elmendorf was simply stating the obvious, that bringing 46 million new people into the system would cost money.

But the testimony emboldened conservative “Blue Dog” Democrats who felt the House’s liberal leaders were ignoring their concerns about costs. House leaders agreed to postpone a floor vote until September.

Warning signs about the cost issue’s volatility came as early as March 4.

Treasury Secretary Timothy Geithner explained the president’s proposal to limit tax deductions for wealthy people as a way to raise money to help pay for expanded health care. But when lawmakers pushed back, Geithner did not dig in.

“We recognize there are other ways to do this,” he told members of Congress. The comment seemed to unleash a flood of ideas, trial balloons and mixed messages.

There were proposals to tax soda pop and increase taxes on alcohol. The Gang of Six senators spent months discussing a new tax on health benefits packages, then dropped it. Now it might be back in play, with Democratic Sen. Max Baucus of Montana proposing a 35 percent tax on the value of insurance plans exceeding $8,000 for individuals and $21,000 for families.

In July, several House committees agreed to a new tax on families making more than $350,000. But House Speaker Nancy Pelosi, D-Calif., said it should apply only to those making more than $1 million.

Obama? He said he didn’t want to raise taxes on families making less than $250,000 a year. But a top Obama economic adviser, Larry Summers, said on Aug. 2 that “it is never a good idea to absolutely rule things out.”

The next day, White House press secretary Robert Gibbs said Obama stood by his campaign pledge not to raise taxes on the middle class.

Republicans appeared quicker to grasp the intricacies and political value of exploiting worries about cost.

On June 19, pollster Wes Anderson traveled to the Capitol to show GOP leaders some surprising results from a poll that his firm, OnMessage Inc., had conducted for Republicans.

Most likely voters wanted to control health care costs, but only one in five wanted greater access to health care. And 90 percent of them already had health insurance, limiting the impact of Obama’s emphasis on covering the uninsured.