Insurance industry representatives later praised his concepts, which had come under criticism by opponents earlier this week.

Speaking to the Illinois State Medical Society, President Bush said that while many factors in the rising costs of health care are necessary, such as research and drug development, the system is also being bogged down by unnecessary expenses.

"Many of the costs that we're talking about don't start in an examining room or an operating room. They start in a courtroom," the president said. "What's happening all across this country is that lawyers are filing baseless suits against hospitals and doctors. That's just a plain fact. And they're doing it for a simple reason. They know the medical liability system is tilted in their favor."

As a result of this imbalance in the judicial system, the president added, health care providers are deciding to settle cases, even those without merit, and passing the costs onto their patients.

"When insurance premiums rise, doctors have no choice but to pass some of the costs on to their patients," he said. "That means you're paying for junk lawsuits every time you go to see your doctor. That's the effect of all the lawsuits. It affects your wallet. If you're a patient, it means you're paying a higher cost to go see your doctor."

The president noted that his audience of doctors in Madison and neighboring St. Clair County are especially aware of the problem. Both counties were listed among the top "judicial hellholes" in an annual survey by the American Tort Reform Association, which described the location "as a national haven for asbestos claims" and malpractice suits.

"In other words," the president said, "if you see a team of trial lawyers spending a lot of time in the Collinsville area, you can be pretty sure they're not looking for horseradish."

Medical malpractice tort reform is one of the areas the president has targeted for spending the "political capital" he believes he earned after the November election. Among the proposals he is pushing for is a $250,000 cap on non-economic "pain and suffering" damages, reserving punitive damages for only the most egregious cases, allowing awards to be paid out over time, and requiring defendants to pay only the percentage of the award equal to their amount of liability.

Mr. Bush said he came to Madison County "because I want to assure you that, one, I understand the problem, and I intend to work with Congress to do something about it."

"You know, when I was the governor of Texas, I felt that we could solve medical liability issues at the state level. And there were two things wrong with that strategy. One is that a state would pass good medical liability reform, and all the trial lawyers would do is go to the state that has lousy medical liability law. So you're not solving the problem, you're just shifting the problem."

Supporters of the president's plan in the industry welcomed the speech and the promise that medical malpractice tort reform will be a priority for the federal government in 2005.

"Today the president clearly stated the need for meaningful legal reforms and his intention to make them a priority during the 109th session of Congress," said Ernie Csiszar, president and chief executive officer of the Property Casualty Insurers Association of America. "The benefits of legal reform, most notably lower insurance premiums and lower product costs for consumers, are essential to the long-term economic success of the United States."

Speaking for health insurers, Karen Ignagni, president and CEO of America's Health Insurance Plans, voiced support for the president and the hope that he will continue to support reforms for class-action suits and medical malpractice litigation he has laid out in the past. "I hope the president will continue with his past themes," Ms. Ignagni said. "It is time to end the litigation lottery."

Ms. Ignagni added, "Our industry hopes the president will lay out a program that will end the irresponsible litigation on the part of the trial lawyers."

John C. Nelson, president of the American Medical Association, also welcomed President Bush's remarks, as well as his choice of location.

"His visit today to Illinois?one of 20 states in a full-blown medical liability crisis?highlights the need for policymakers to enact proven reforms to prevent the crisis from becoming worse," Dr. Nelson said.

Dr. Nelson added that the crisis is especially acute in southern Illinois, where Madison and St. Clair counties are located. "It is a simple fact that the state's out-of-control legal system has driven insurance premiums sky-high and forced high-risk specialists, including neurosurgeons and obstetrician-gynecologists, to restrict services, retire early and leave the state," he said "We are deeply concerned that southern Illinois residents?or anyone driving through the state?could lose their life because of this crisis."

Earlier in the week, opponents of the president's proposals made a pre-emptive strike, holding a conference call with reporters.

Jay Angoff, director of the Missouri Department of Insurance from 1993 to 1998, said during the conference call, "The president is doing the wrong thing at the wrong time in the wrong place." Mr. Angoff added, "Insurance companies have never made more money than they did in 2004," citing a large industry surplus. Mr. Angoff said the insurers are "rolling in dough; they're swimming in dough."

Rep. Janice Schakowsky, D-Ill., talked during the conference call about testimony she has heard at various congressional hearings, notably from insurance industry officials testifying that the industry can't guarantee rate decreases if caps are set.

She noted that statistics showed medical malpractice insurance rates for doctors increased more in states with caps than elsewhere and added that she didn't think it was surprising that rates might be higher in Illinois, because there's "virtually no regulation." She said that President Bush's likely proposal had "built-in discrimination," and "it really discriminates against women and children."

Instead, Rep. Schakowsky said the problem of medical malpractice rates should be dealt with from an insurance regulation perspective rather than through tort reforms. "We need to deal with insurance regulation, and we need to deal head on with the problem of malpractice and medical mistakes," she said.