ANNANDALE, Va. - President Barack Obama wanted to put a human face on his plans to overhaul health care, and a Virginia woman did just that Wednesday. Fighting back tears, Debby Smith, 53, told Obama of her kidney cancer and her inability to obtain health insurance or hold a job.
The president hugged her - she's a volunteer for his political operation - 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 Smith as hundreds looked on at a community college forum - and countless others watched on television. But the nation's long-term needs require a greater emphasis on preventive care and "cost-effective care," he said.
Smith, of Appalachia, Va., is a volunteer for Organizing for America, Obama's political operation within the Democratic National Committee. She obtained her ticket through the White House.
The health care changes that Obama called for Wednesday would reshape the nation's medical landscape. He says he wants to cover nearly 50 million uninsured Americans, to persuade doctors to stress quality over quantity of care, to squeeze billions of dollars from spending.
But details on exactly how to do those things were generally lacking in his hour-long town hall forum before a supportive audience in a Washington suburb. The lingering questions underscore the tough negotiations awaiting Congress, the administration and dozens of special interest groups in the coming months. Lawmakers will return to debating the issue when they return from a one-week recess on Monday.
Some of Obama's questioners Wednesday were from friendly sources, including a member of the Service Employees International Union and a member of Health Care for America Now, which organized a Capitol Hill rally last week calling for an overhaul.
Obama made no new proposals at the sometimes emotional event. But he vigorously defended his plans while fielding seven questions from the live audience at the forum and on the Internet.
The president would bar insurance companies from turning down applicants because of their "pre-existing conditions." He would establish health care exchanges that would spread the costs of treating patients such as Smith over a large number of people.
Obama called for shifting huge sums of money from current health care spending to new goals. About two-thirds of the overall new costs "will come from reallocating money that is already being spent in the health care system but isn't being spent wisely," he said.
He restated his pledge to cut $177 billion over the next decade from Medicare Advantage insurance plans. And he noted that doctors, hospitals, corporations and others have pledged to decrease the annual rate of spending growth by 1.5 percent, or $2 trillion over 10 years.
Such savings are not guaranteed, however, and many Republican lawmakers say Obama's plans will prove too costly.
"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.
One questioner said limits on awards from medical malpractice lawsuits would bring down health care costs.
Obama replied, "I don't like the idea of an artificial cap" on such awards for a patient's injuries. He also said there was 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 specifics for a problem that has vexed the medical and legal industries for decades.
The president repeatedly said the current health care system is not acceptable and must be overhauled this year. He urged the audience, which included people following on Facebook and YouTube, to reject critics who say his plans are too costly or a step toward socialized medicine.
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.