President Barack Obama asked skeptical doctors Monday to get behind an overhaul of the nation's health care system, declaring it a "ticking time bomb" for the budget that could force America to "go the way of GM."
The difficulty of his task was evident when he said he's against capping awards in malpractice lawsuits, a top priority for doctors, and earned a smattering of boos -- a remarkable public response to a popular president accustomed to cheering audiences.
Flying to his hometown to speak at the annual meeting here of the American Medical Association, Obama struck back forcefully at those speaking out against his efforts to reshape the health care delivery system to bring skyrocketing health care costs under control and expand coverage to the millions of uninsured.
He had his sharpest rhetoric yet for critics, calling them "naysayers," "fear-mongers" and peddlers of "Trojan horse" falsehoods who should be ignored. He warned interest groups and lobbyists not to use "fear tactics to paint any effort to achieve reform as an attempt to socialize medicine."
"There are those who will try and scuttle this opportunity no matter what," Obama said.
The president directly took on criticism on Sunday from former Republican presidential candidate Mitt Romney, though not by name. Romney, widely expected to consider another run at the White House in 2012, called Obama's support for creating government-sponsored insurance as an option alongside private coverage a "Trojan horse" for a single-payer system like Great Britain's.
"When you hear the naysayers claim that I'm trying to bring about government-run health care, know this: they are not telling the truth," Obama said.
Even before Obama spoke, Republicans offered push-back.
GOP Rep. Tom Price of Georgia -- a former orthopedic surgeon -- accused Obama of pushing a "government takeover" of health care. Speaking to reporters on a conference call organized by the Republican National Committee, Price contended that a committee that Obama's administration has established to study the effectiveness of various medical treatments would turn into a "rationing board" to overrule doctors and deny patients care.
The president said for the first time publicly that health care reform, including covering the almost 50 million Americans who have no insurance, will cost about $1 trillion over 10 years.
"That's real money, even in Washington," he said. "But remember: That's less than we are projected to have spent on the war in Iraq. And also remember: Failing to reform our health care system in a way that genuinely reduces cost growth will cost us trillions of dollars more in lost economic growth and lower wages."
Aides have said previously that the administration wants to keep the cost around $1 trillion, while also acknowledging it may go higher.
Obama has taken steps in recent days to outline just where that money could be found.
For instance, he wants to cut federal payments to hospitals by about $200 billion and cut $313 billion from Medicare and Medicaid over 10 years. He also is proposing a $635 billion "down payment" in tax increases and spending cuts in the health care system.
Obama traveled to Chicago to talk to the 250,000-physician group in hopes of persuading doctors not to fight him. The nation's doctors, like many other groups, are divided over the president's proposals.
He drew hearty applause with a focus on the particular concerns of the medical profession: telling them any system that relies on them "to be bean-counters and paper-pushers" is out of whack and that his push to investigate best-practices and eliminate unnecessary procedures "is not about dictating what kind of care should be provided."
"I need your help, doctors," he said. "To most Americans, you are the health care system. Americans me included just do what you recommend. That is why I will listen to you and work with you to pursue reform that works for you."
But the malpractice issue is the most provocative with this audience. Doctors chafe at the rising and eye-popping costs of malpractice insurance, and support limits on malpractice lawsuits.
Obama started by sympathizing with doctors "who feel like they are constantly looking over their shoulder for fear of lawsuits" and with their desire for some way to curb them. The crowd burst into loud support.
"Don't get too excited yet. ... Just hold onto your horses here, guys," Obama said as he prepared delivered the disappointing news.
"I want to be honest with you. I'm not advocating caps on malpractice awards," the president. He explained that he thinks such limits would be unfair to harmed patients-- a line interrupted by boos. Instead, he said, without offering specifics, that expensive "excessive defensive medicine" can be curbed in other ways.
Democrats have long opposed caps on medical malpractice payouts -- something former President George W. Bush pushed for.
In Washington, GOP Sens. Jon Kyl and Mitch McConnell, the Senate's minority leader, announced legislation that would bar the federal government from using medical effectiveness research to deny care.
Obama administration officials have argued repeatedly that their goal is to collect more information for patients and doctors, not prevent anyone from getting needed treatments.
Trial lawyers' groups also stepped up their efforts.
The Center for Justice and Democracy, which says it advocates for injured consumers, attorneys and others, released a letter to Obama signed by 64 survivors of medical malpractice saying they didn't want to be used as a "political bargaining chip" in the president's efforts to win support from doctors.
"We are extremely concerned that the rights of medical malpractice patients may be stripped away as part of your national health care proposal," they wrote.
The main lobby for trial lawyers also disputed Obama's statement that it's "a real issue" that doctors order more tests and treatments to avoid legal liability.
"The notion that 'defensive medicine' is leading to higher health care costs is not supported by empirical data or academic literature," Les Weisbrod, president of the American Association for Justice, said in a statement after Obama's speech.
"Limiting the legal rights of injured patients will do nothing to lower health care costs or aid the uninsured," Weisbrod said.
Obama co-sponsored legislation with Hillary Rodham Clinton when both were in the Senate in 2005 that would have created a program to allow patients to learn of medical errors and establish negotiated compensation with the offer of an apology.
Obama said he's "open" to requiring all Americans to have health insurance, while stressing that the plan would permit continuing assistance for those who cannot afford it on their own. A "health care exchange" would be set up to provide additional options for the uninsured.
"A big part of what led General Motors and Chrysler into trouble," he said, "were the huge costs they racked up providing health care for their workers -- costs that made them less profitable and less competitive with automakers around the world."
"If we do not fix our health care system," Obama said, "America may go the way of GM -- paying more, getting less, and going broke."
Obama has been speaking privately with lawmakers about his ideas and publicly with audiences, such as a town hall style meeting last week in Green Bay, Wis. Obama and administration officials have blanketed the nation in support of his broad ideas, and Vice President Joe Biden on Sunday said it's up to Congress to pin down the details on how to pay for them.