U.S. President Barack Obama may face a tough sale as he tries to get physicians on board his healthcare overhaul.

While doctors agree with the need to revamp the system, they are skeptical that reform could hurt them financially or compromise the quality of care.

In a speech on Monday to the American Medical Association (AMA), which represents 250,000 doctors, Obama stressed the need for reform and urged physicians to support his proposal.

"If we do not fix our healthcare system, America may go the way of GM -- paying more, getting less and going broke," he said, comparing healthcare to bankrupt automaker General Motors.

The president's speech came as the debate over reform has been heating up. The Congress is hammering out a bill, but questions linger over how to pay for a new plan and whether it should include a public insurance program.

Physicians fear that public insurance could mean that employers, from whom most Americans receive coverage, could switch over to the cheaper government plans.

Greg D'Angelo, policy analyst at the Heritage Foundation, a think tank in Washington D.C., said this competition could hurt private insurers and even cause some to close their doors.

Indeed, 70 percent of private insurance patients could be pushed into a public plan, which would cost 25 percent to 40 percent less than private insurance premiums, D'Angelo said.

Thus physicians fear a government program would provide substandard care and force patients to wait in long lines for routine procedures. Moreover, patients would have few other choices once private insurers were pushed out, opponents said.

Robert Moffitt, director of the Center for Health Policy Studies at the Heritage Foundation, said that in a worst scenario, fewer graduates would choose to go into medicine and doctors would become overworked and underpaid.

D'Angelo said there would, however, be benefits to a plan that seeks to insure the entire population, as it would reduce uncompensated care. But doctors would receive less money per patient, he added.

Despite such fears, most physicians are still in favor of health care reform.

"Doctors are emotionally with Obama in wanting to give more Americans health insurance," said Hans Kuttner, visiting fellow at the Hudson Institute, another Washington D.C. think tank, but adding that they are wary of anything that might hurt their wallets.

During his speech, Obama tried to alleviate such worries.

"I understand you are concerned that today's medicare rates will be applied broadly in a way that means our cost savings are coming off your backs," Obama said. "These are legitimate concerns, but ones, I believe, that can be overcome."

In response to fears that a new system could come between physicians and patients, Obama has also stressed that those who like their doctors can keep them.

Supporters of the president's plan said the reform was unlikely to damage the quality of healthcare.

Larry Kocot, deputy director of the Engelberg Center for Health Care Reform at the Brookings Institution, also a Washington D.C. think tank, said fears of diminished quality were overblown, and saw no evidence for such conclusions.

Ellen-Marie Whelan, senior health policy analyst at the Center for American Progress, said that a major part of Obama's plan would be market-based and it would enhance the current system, not denigrate it.

Indeed, during his speech, the president spoke in detail about the "health insurance exchange," a proposal that helps Americans compare all available private health care plans and enroll in one location that suits them best.

He emphasized that those who were content with their plans could keep them, but those seeking new coverage would have more options.

Physicians have long complained about paying expensive malpractice insurance premiums and would likely support a bill that included limits on malpractice awards, Kuttner said.

Obama raised the subject during his speech, saying that doctors should not have to constantly worry about avoiding lawsuits, a statement that sparked thunderous applause. But the audience quickly simmered down when he said he did not favor limits on malpractice suits, media reported. Doctors and many others also fret over costs.

Part of what is spurring healthcare reform is that the U.S. system is one of the world's most expensive, experts said.

According to government figures, healthcare costs are expected to rise from nearly 18 percent of Gross Domestic Product in 2009 to around 20 percent, or US$4.4 trillion, by 2018. Costs are expected to outstrip GDP growth by around 2 percent annually.

Critics said that so far, the Congress has not found a way to alleviate this burden.

On Monday, the Congressional Budget Office released a preliminary estimate saying that the Senate's current healthcare plan, which closely resembles Obama's healthcare vision, would tack an extra US$1 trillion onto the deficit over the next decade and still leave millions uninsured.

Obama, however, disagreed. "There are already voices saying the numbers don't add up. They are wrong," Obama said, outlining his proposals to pay for the plan, including spending cuts and tax hikes on wealthier Americans.

Following the president's speech, the AMA said it was still too soon to judge his healthcare plan without knowing the details, which are still being debated in Congress.

Going forward, the president said the input of doctors and medical professionals was key to implement the best system for everybody. "We listen to you, we trust you. And that's why I will work with you to pursue reform that works for you."

(Xinhua News Agency June 19, 2009)