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In Pitch to AMA, Obama Paints Mixed Picture

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Washington Post Staff Writer
Tuesday, June 16, 2009

CHICAGO, June 15 -- 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 a newly aggressive effort to line up industry support for an overhaul of the nation's health system.

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

The president's 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.

For months, Obama remained on the sidelines of the health-care debate because "he felt it was important to not be too proscriptive," Axelrod said in an interview. "Now we're into a different phase, where decisions are being made very quickly, so it's time to weigh in to a greater degree."

The Obama strategy, articulated in the speech here and in a series of private meetings, is to present each major stakeholder with an enticement in return for a bit of sacrifice.

To insurers, Obama offered a concession and a warning. In a shift from his position during the presidential campaign, he is willing to support a requirement that every American have health insurance, which could translate into more than 40 million new customers for the industry.

"Insurance companies have expressed support for the idea of covering the uninsured -- and I welcome their willingness to engage constructively in the reform debate. I'm glad they're at the table," Obama said. "But what I refuse to do is simply create a system where insurance companies suddenly have a whole bunch more customers on Uncle Sam's dime but still fail to meet their responsibilities."

Some interest groups have begun to balk as the president has staked out his position in greater detail.

Over the weekend, Obama outlined $313 billion in cuts to Medicare and Medicaid aimed primarily at the revenue of hospitals and drugmakers.

The American Hospital Association said in a statement that it was "deeply disappointed and concerned" by the announcement.

"Hospitals have long supported expanding health care coverage to all Americans but feel this must happen while maintaining adequate financing for hospitals that serve large numbers of poor and uninsured patients," the group said.

Lobbyists for leading drug companies also were unenthusiastic, saying privately that Obama cannot expect to pay for his ambitious expansion of health coverage by squeezing the private sector.


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