national

CHICAGO - President Obama wooed the American Medical Association on Monday with talk of curbing malpractice lawsuits and canceling a proposed 21 percent cut in Medicare payments as he ramped up an effort to win support for a major overhaul of the nation's health system.

But he refused to endorse the group's top goal -- limits on legal damage awards -- and he defended the creation of a government-sponsored health insurance program that many physicians oppose. "The public option is not your enemy; it is your friend," Obama said.

His good-news, bad-news message to the physicians marked what White House senior adviser David Axelrod described as a higher level of engagement by the president on his top domestic priority.

The Obama strategy, articulated in the speech here and a series of private meetings, is to present each major stakeholder -- insurers, lobbyists, doctors, hospitals -- with an enticement in return for a bit of sacrifice. "The message is everybody has got to put something on the table," said Sen. Ron Wyden, D-Ore.

In Chicago, Obama brought the doctors to their feet with a hint he is willing to provide some level of malpractice relief, perhaps the top legislative priority of the physicians' lobby. "Now, I recognize that it will be hard to make some of these changes if doctors feel like they're constantly looking over their shoulders for fear of lawsuits," he said.

But he also drew some boos when he warned he would not give them what they most desire. "I want to be honest with you," he said. "I'm not advocating caps on malpractice awards, which I personally believe can be unfair to people who've been wrongfully harmed."

James Rohack -- incoming president of the AMA, the nation's largest physician group with 250,000 members -- said doctors must receive some legal protection if they are going to reduce extra tests, as Obama urged. "Unless we have protection ... we're going to order those additional tests."

Despite concerns about that issue, Dr. Noel Peterson, Minnesota Medical Association president who attended the speech, said the audience was unusually receptive. "Remarkably few people were not applauding or remained seated," he said.

Unlike the Clinton administration's plan to overhaul health care, which was crafted behind closed doors, he said: "One of the things that seems very new is the White House's interest in continuing the conversation, keeping people at the table."

He noted that some of Obama's proposals were similar to Minnesota's efforts, including finding a way to pay for quality rather than quantity.

The speech also was followed by doctors in Minnesota. "'It was a very good speech" that managed to hit the big themes in health care, said Dr. Scott Davies, head of the Department of Internal Medicine at Hennepin County Medical Center.

But he said how the president gets to the goal of insuring everybody remains to be seen. In pushing for a new public insurance plan while also assuring those with private insurance that they could keep their doctor and their plan, Obama seemed to be "trying to have it both ways," Davies said.

HCMC is the biggest safety net hospital in the state and has borne the brunt of caring for the uninsured.

Staff writer Chen May Yee contributed to this report.

Overhauling financial rule book: Obama to unveil a plan to give the Fed new powers; Restructuring to be scaled back. D1