WASHINGTON, June 15, 2009 — -- Paying a house call to some of his toughest critics today, President Obama appeared before the nation's leading doctors' group, stressing the urgent need for health care reform, defending a proposal to provide a public health care option to give Americans more choice in their coverage, and opposing caps in payments for medical malpractice awards.
"We are not a nation that accepts nearly 46 million uninsured men, women and children. We are not a nation that lets hardworking families go without the coverage they deserve, or turns its back on those in need. ... We need to get this done," he said to applause.
In public and private the AMA has been pushing the president to address the reason for all the unnecessary tests, referrals and hospital stays their members order because, they say, they practice defensive medicine to fend off voracious trial lawyers. The president addressed their concerns today, though likely not to their satisfaction.
"Some doctors may feel the need to order more tests and treatments to avoid being legally vulnerable," the president said. "That's a real issue. And while I'm not advocating caps on malpractice awards which I believe can be unfair to people who've been wrongfully harmed, I do think we need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine, and encourage broader use of evidence-based guidelines."
The president pushed for a health care system that focused on results. "You did not enter this profession to be bean-counters and paper-pushers," he said to loud applause. "You entered this profession to be healers -- and that's what our health care system should let you be."
"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," the president said.
"Health care reform is the single most important thing we can do for America's long-term fiscal health. That is a fact," he said.
Obama outlined his support for a health insurance exchange that could bring down costs by setting up a system in which private health plans compete with a public option and consumers have more choices.
"You will have your choice of a number of plans that offer a few different packages, but every plan would offer an affordable, basic package. And one of these options needs to be a public option that will give people a broader range of choices and inject competition into the health care market that [will] force waste out of the system and keep the insurance companies honest," he said.
On this key issue, Obama faces significant opposition from Senate Republicans, who believe the public option is a slippery slope to government-run health care.
Senate Minority Leader Mitch McConnell of Kentucky Sunday called the idea a "nonstarter."
Today Obama pushed back hard at his critics.
"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," he said. "What I am trying to do, and what a public option will help do, is put affordable health care within reach for millions of Americans."
Obama pitched this idea to a skeptical audience -- the AMA has expressed its concerns with the public option.
"That doesn't mean we oppose," AMA president Nancy Nielsen said. "It means we would like to talk about perhaps other options."
Health and Human Services Secretary Kathleen Sebelius said Sunday that the administration remains committed to a public option.
"That's a direction he thinks will be beneficial for the public and for -- to make sure that costs go down. And that's a central belief of his. This has to lower costs for everyone," Sebelius said on ABC's "This Week With George Stephanopoulos." "In lots of places in the country, absent a public option, absent some kind of competitive option, people would have no choice."
Today, Obama emphasized that these changes would not affect all Americans. If you are happy with your health care, you will get to keep it.
"My view is that health care reform should be guided by a simple principle: Fix what's broken and build on what works," he said.
Obama argued that the nation's health care system equates expensive care with better care, and too much money is being spent on treatments that do not actually make Americans healthier.
To fix that system, and allow doctors to be "healers" and not "bean-counters and paper-pushers," Obama said there need to be changes to how doctors are compensated and how they are informed of new medical information and innovations.
Health Care Debate: Proposed Malpractice Changes May Not Satisfy Doctors
In his May 11 meeting with leaders of the health care industry, AMA's incoming president Dr. James Rohack told Obama that one of the reasons health care costs are so high is because doctors order unnecessary tests, referrals and hospital stays because they're practicing "defensive medicine" and fearing malpractice lawsuits.
"What we asked the president is that if we, as physicians, are willing to tackle the issue of looking at variation of care and reducing unnecessary tests, we also have to have protection in the courtroom," Rohack told ABC News after the meeting, that "if we didn't order a test, that we subsequently aren't going to get sued because we didn't order that test that shouldn't have been done in the first place."
So, for example, not everyone who comes into the emergency room complaining about a headache would automatically get an MRI, Rohack said.
Obama said today he is open to considering ideas on how to ensure patient safety but allow doctors to practice medicine. "That's how we can scale back the excessive defensive medicine reinforcing our current system of more treatment rather than better care," he said.
Obama: 'We Cannot Let This Moment Pass Us By'
Obama is the first president to address the AMA since Ronald Reagan in 1983. The AMA opposed the ambitious health care plan that former President Bill Clinton attempted in 1994, but the doctors group wants a seat at the table this time, recognizing that some kind of change is inevitable.
Obama noted today that many of his predecessors, going back to Teddy Roosevelt, called for health care reform but most efforts failed because the parties involved could not agree on a way forward.
The president said that things are different today because the key players, including the AMA, are coming together to make changes in order to achieve reform.
"We know the moment is right for health care reform. We know this is an historic opportunity we've never seen before and may not see again. But we also know that there are those who will try and scuttle this opportunity no matter what -- who will use the same scare tactics and fear-mongering that's worked in the past," he said.
Obama recounted a story in which Rep. Earl Blumenauer, D-Ore., gave him a magazine with a special report on "The Crisis in American Medicine" that addressed many of the key challenges that he is talking about today, except the article was dated October 1960.
"I know people are cynical we can do this. I know there will be disagreements about how to proceed in the days ahead. But I also know that we cannot let this moment pass us by," he said.
ABC News' John Hendren contributed to this report.