Vice President Cheney, with a swipe at his Democratic trial-lawyer counterpart, yesterday blamed rising health care costs on "runaway litigation" and promoted a $250,000 cap on medical malpractice awards as the central tenet of the White House program to improve access, affordability and quality of care.

Articulating a health policy vision nearly opposite the one advocated by the Democratic presidential ticket, Cheney promoted individual tax credits, additional community health centers and more modern technology as ways to help Americans afford top-notch medical care.

But it was medical malpractice that dominated his address at the Medical College of Ohio in Toledo, and it is limits on lawsuit damages that remain the most ambitious proposal of the Republican ticket's health care agenda.

"This problem doesn't start in the waiting room," Cheney said in remarks released by the campaign. "It doesn't start in the operating room. The problem starts in the courtroom."

With lawsuits on the rise and multimillion-dollar awards making headlines, physicians and many Republicans say limiting damages is the solution to the broader challenges confronting the U.S. health system. In their analysis, capping damages will lead to lower malpractice premiums, which will reduce doctors' use of unnecessary tests and procedures, known as defensive medicine. Those improvements will result in better care at a lower cost, enabling more people to buy coverage, they say.

"When it comes to the legal crisis in American health care, the Kerry-Edwards ticket is on the side of personal-injury trial lawyers, and the Bush-Cheney ticket is on the side of doctors and patients," Cheney said, noting that Sen. John Edwards (N.C.) "is a trial lawyer who is very experienced at suing doctors."

Strategically, the Bush team has decided to spotlight tort reform because "most people in this country have some form of insurance, and they're worried about how much it costs," said senior strategist Matthew Dowd.

A report by the Department of Health and Human Services found that expenses traceable to legal liability fears contribute between $60 billion and $108 billion a year to the total $1.6 trillion health care bill. Legislation imposing a $250,000 cap on non-economic damages would result in 4 million more people receiving health insurance, according to Congress's Joint Economic Committee.

"The broken medical liability system has a great impact on access to care and what happens to a patient who can't find a physician in his or her hour of need," said Donald Palmisano, the immediate past president of the American Medical Association, which supports the bill. He said veteran doctors in specialty areas such as obstetrics and neurosurgery are retiring, and a recent survey of physicians found that up to 70 percent order tests or procedures in case they are sued.

An analysis by the Congressional Budget Office said the malpractice bill would benefit physicians and the government but would reduce private health insurance premiums a scant 0.4 percent.

"The Bush administration largely gets it backwards," said Columbia University law professor and physician William M. Sage. "They say health care is expensive because of lawsuits. I say lawsuits are expensive because of our health care system."

Edwards and Sen. John F. Kerry (Mass.) have consistently voted against limits on damage awards, arguing that malpractice suits have little impact on health spending but remain an important option for patients severely injured by medical errors.

"Senator Kerry and I stand with families and kids as we always have and as we believe it's important for the president and the vice president to do, instead of being on the side of insurance companies and big drug companies, which is, unfortunately, where they are," Edwards said during a campaign stop in North Carolina.

Behind the rhetorical sparring is a real problem that is not being addressed, said several legal and medical experts.

"The solution that organized medicine and the White House are supporting is a fix for the doctors to some degree," said Martin J. Hatlie, president of the Chicago-based Partnership for Patient Safety, which advises hospitals on safety improvements. "It helps keep their premiums down. It does nothing to advance the quality of care, nothing to advance the safety of care, nothing to more fairly compensate claimants or address the other really significant problems in the current medical-legal system."

Sage is advocating changes to the Medicare and Medicaid programs to link liability costs and reimbursement rates. Under his voluntary system, the government would offer financial incentives to hospitals that institute speedy resolution of medical errors. Doctors and hospitals would be protected from huge lawsuits if they promptly notified patients of mistakes and offered adequate compensation.

During the Democratic primaries, Kerry unveiled his ideas for medical malpractice, which would shift largely to a mediation system and sanctions against lawyers with a history of frivolous lawsuits.

Cheney said caps on awards must be part of the equation, "otherwise insurance premiums and patient costs will continue spiraling out of control."

Staff writer Vanessa Williams contributed to this report.