PHILIP ELLIOTT, Associated Press Writer

ANNANDALE, Va. (AP) — At an emotional forum in Virginia, President Barack Obama hugged a cancer patient Wednesday and vowed to bring greater efficiency and accessibility to the nation’s health care system.

A woman named Debbie fought tears as she told Obama of her kidney cancer and her inability to obtain health insurance or hold a job. The president hugged her and called her “exhibit A” in an unsustainable system that is too expensive and complex for millions of Americans.

“We are going to try to find ways to help you immediately,” he told her as hundreds watched at a community college forum — and countless others on television. But the nation’s long-term needs require a greater emphasis on preventive care and “cost-effective care,” he said.

Obama said the best way to drive down health care costs is to persuade doctors and hospitals to emphasize quality of care over the quantity of procedures.

Health experts have long criticized formulas that tie Medicare payments to tests and other services that may not always be the best way to treat a patient. Obama said the formulas must change as part of his bid to overhaul U.S. health care delivery.

“The biggest thing we can do to hold down costs is to change the incentives of a health care system that automatically equates expensive care with better care,” the president said. He said the formula system drives up costs “but doesn’t make you better.”

Obama did not make specific recommendations for changing the incentive formulas.

He gave a lengthy sales pitch for his general overhaul proposals and then fielded questions from audience members, including Debbie, and from other people through the Internet.

Obama said a government-run “single-payer” health care system works well in some countries. But it is not appropriate in the United States, he said, because so many people get insurance through their employers working with private companies.

But he again called for a government-run “public option” to compete with private insurers, a plan that many Republicans oppose.

Obama said the public option would provide “competition and choice” and “keep insurers honest.”

Obama also said his health care plan would benefit small businesses and people who are self-employed, by giving them more leverage in dealing with insurance companies. He would do it through a health care exchange for employers who have too few workers to get a good health insurance package, and for people who are self-employed.

Obama said they would be able to look at the plans available and join with others in the same situation. They would become part of a “big pool” with the leverage to drive down costs, he said.

When a man from Texas said limits on awards from medical malpractice lawsuits would bring down health care costs, the president replied, “I don’t like the idea of an artificial cap” on such awards for injuries suffered. He also said there is little evidence that various states’ efforts to limit such awards have uniformly brought down costs.

Obama said, however, that he is working with the American Medical Association to explore ways to reduce liability for doctors and hospitals “when they’ve done nothing wrong.” He offered no details.

Congress will return to debating health care when it returns Monday from a one-week recess. Obama’s agenda calls for reducing delivery costs even as insurance coverage is extended to virtually all Americans.

Obama says the government will not borrow money to carry out the plans, but many Republicans are dubious if not outright hostile to his proposals.

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