ANNANDALE, Va. (AP) -- President Barack Obama hugged a cancer patient Wednesday at an emotional forum before a supportive audience and vowed to bring greater efficiency and accessibility to the nation's health care system.
Debby Smith, 53, of Appalachia, Va., a volunteer for Obama's political operation, fought tears as she told the president of her kidney cancer and her inability to obtain health insurance or hold a job. Obama embraced her and called her "exhibit A" in what he said was 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 obtained her ticket through the White House. Aides said she was a volunteer for Organizing for America, Obama's political operation within the Democratic National Committee. Among the other questioners were a member of the Service Employees International Union and a person with Health Care for America Now, which recently organized a Capitol Hill rally for overhauling health care.
Also questioning the president - via the Internet - was Republican Rep. Michael Burgess of Texas, an obstetrician.
Obama aides said half the tickets were distributed through the community college, with the balance handled through the White House.
The president 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. Nor did he offer new proposals or details for other tough issues, such as whether to limit medical malpractice awards or to tax employer-subsidized health care benefits.
He 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 gave a nearly 20-minute introduction and answered seven questions.
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 specifics.
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.