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Center executives said the initiative, on which they spent $2 million last year, could be a national model. Critics, however, describe the program as an attempt to ensure that the hospital retains only affluent patients with insurance.

"If you put enough money into it, you could save a whole bunch of community health centers," Young said. "But to date, they haven't."

Edward Novak, president of Chicago's Sacred Heart Hospital, declined to discuss the center's initiative in particular but dismissed as "bull" attempts to justify such programs as good for patients. "What they're really saying is, 'Don't use our emergency room because it will cost us money, and we don't want the public-aid population,' " Novak said.

Selling the Idea

In December 2006, the medical center hired a public relations firm, ASK Public Strategies, to help sell the Urban Health Initiative. ASK is co-owned by Axelrod, Obama's chief campaign strategist.

ASK was selected on the recommendation of Michelle Obama, Sher and Jarrett, according to Sullivan, the hospital spokeswoman. "Axelrod has a love affair with UC, and is arguably the best in the country at public affairs," Sullivan said in an e-mail.

ASK started work in January 2007; the next month, Barack Obama launched his campaign.

The firm delivered its report in May 2007 saying that, while nurses were generally favorable about the Urban Health Initiative, "primary care doctors were more negative, viewing it as a break with UCMC's community commitment."

An April 2007 draft report from the medical center's polling firm, Peter D. Hart Research Associates, said focus groups suggested that "enough latent suspicion toward the hospital and university as elitist exists to ensure that a political attack against the Urban Health Initiative as deceptive and self-serving would find fertile ground."

While most of those surveyed expressed favorable views of the center and its program, critics complained of arrogance and a lack of empathy, the report said.

"More than a few staff members -- particularly medical staff -- express strongly worded concern or disappointment with UCMC in its commitment to the community," the report said.

One survey question asked for reaction to a particular criticism that had been leveled:

"This new health initiative is not really about helping the residents of the South Side of Chicago. It is simply a way for the University of Chicago Medical Center to save money and reduce costs by serving fewer poor people without health insurance."