President Bush made a pocketbook appeal for nationwide ceilings on medical malpractice (search) awards Monday, asserting that "junk" lawsuits cost taxpayers because they drive the federal government's health care costs up by $28 billion a year.

Bush took an implicit swing at Sen. John Edwards (search), a Democratic presidential contender who made millions as a lawyer trying personal injury lawsuits against big companies. Edwards finished a surprising second in the Iowa caucuses last week.

The health care system looks like a giant lottery, that's what it looks like these days with these lawsuits, and somehow the trial lawyers always hold the winning ticket," Bush said to an audience of several hundred medical professionals and others in a hospital auditorium here.

"Lawyers walk away with up to 40 percent -- 40 percent -- of every settlement and verdict," Bush said. He said many such lawsuits are "frivolous" and are "driving a wedge between the docs and their patients," he said.

Bush argues that a nationwide cap on such lawsuits would drive down soaring health care costs and save taxpayers money.

Legislation that died last year in Congress would have limited the pain and suffering portion of malpractice awards to $250,000 and punitive damages (search) to either the same amount or twice the patient's actual financial loss. The bill, intended to supersede state laws, also would curtail lawyers' fees and patients' ability to file suit over old cases.

Senate Democrats stalled the bill last year, arguing it would help the insurance industry, not patients. Bush renewed his effort to enact the measure last week in his State of the Union address, and chose this key electoral swing state to carry the message Monday.

With 43 million Americans uninsured, Bush offered a five-pillared strategy for confronting the issue -- most of them repackaged ideas he had previously advocated.

Facing record budget deficits, Bush chose measures that would require little government spending.

They include setting medical malpractice limits; helping small businesses to band together to negotiate for lower insurance rates; offering refundable tax credits to help low-income Americans purchase health insurance; creating tax incentives to encourage the use of health savings accounts (search), which would let people save money for future medical expenses tax-free; and harnessing medical technology to prevent medical errors.

"We've got to deal with rising health care costs. They are making it difficult for some people to hire," Bush said. "We want our families to feel more secure, (but) rising health care costs create insecurity in our nation."

Medical malpractice caps are a favorite remedy of Republicans who seek to tackle rising health care costs.

Bush did not define precisely which lawsuits "don't have any merit" in his view. According to the president, medical liability premiums for Arkansas doctors rose more than 150 percent last year.

"Hear me out on this: (unnecessary lawsuits) drive docs to prescribe drugs and procedures that may not be necessary, just to avoid lawsuits. That's called the defensive practice of medicine."

Such "defensive" responses by doctors affect the federal government, which delivers or subsidizes health care through such programs as Medicare and veterans' health benefits, he said.

The American Medical Association (search) lined up behind Bush, as it did last year when he first started campaigning for the reforms.

"America's broken liability system is severely jeopardizing patients' access to care," the AMA said in a prepared statement praising Bush's revived campaign.

The AMA named Arkansas a state "in crisis" last year. "Because of the millions paid out in jury awards and verdicts, as well as the high costs to defend frivolous lawsuits, physicians insurance premiums have skyrocketed in Arkansas and in many other parts of the country," said AMA President Dr. Donald J. Palmisano. "In the 19 crisis states, physicians are taking early retirement, or abandoning high-risk services, because they cannot afford or find liability insurance."

There was a whiff of re-election politics in the air with Bush's revived campaign on malpractice awards. Karl Rove, Bush's top political adviser, traveled to Arkansas with Bush.

Bush is eager this year to capture Arkansas -- a traditionally Democratic state that he narrowly won in 2000 and is the home of another Democratic contender, Wesley Clark.