STRONGSVILLE, Ohio -- Opening what may be remembered as the climactic sprint in the marathon debate on health care, President Barack Obama called for courage to address the needs of patients ill-served by the nation's current insurance system.

In this economically lagging state, the president rebutted critics who contend the plan would weaken Medicare while saying that the legislation would represent a significant middle-class tax break.

He spoke as congressional opponents and public opinion surveys suggested that he had yet to rally the nation behind his proposals. An aggregation of surveys on health care on the website Pollster.com showed that he still faces skepticism with 51 percent disapproving of his approach and 41 percent supporting it.

But Mr. Obama urged his listeners to ignore polls and political handicapping in confronting the divisive issue.

The president doffed his suit jacket and rolled up his shirt sleeves as he approached the microphone in one more attempt to close the deal on his administration's chief legislative priority.

Before a gym packed with roughly a thousand vocal supporters, Mr. Obama opened with a vignette about a local woman, Natoma Canfield, who wrote to him earlier this year, describing how, after years of paying ever-rising premiums, she had to give up her health care coverage in January when faced a 40 percent price increase. After her decision to drop coverage, Mr. Obama said, she was diagnosed with leukemia and now faces an extended regime of chemotherapy with no means to pay for it.

Mr. Obama read the same letter to a group of insurance executives at a recent White House meeting pressing his case for reform.

"She is racked with worry not only about her illness but about the costs of the tests and the treatment that she's surely going to need to beat it."

"So you want to know why I'm here, Ohio? I'm here because of Natoma," he said to applause. "I'm here because of the countless others who have been forced to face the most terrifying challenges in their lives with the added burden of medical bills they can't pay. I don't think that's right."

Responding to Republican calls for a new round of negotiations in pursuit of a compromise bill, he added: "And so when you hear people say 'start over' -- I want you to think of Natoma. When you hear people saying that this isn't the 'right time' -- think of what she's going through."

Throughout the 35-minute speech, Mr. Obama fed off of an enthusiastic crowd. At one point, as Mr. Obama dismissed warnings about the political repercussions of the controversial legislation, a member of the crowd shouted out, "We need courage!"

"We need courage," the president echoed to loud applause. "Did you hear what somebody just said? That's what we need. That's why I came here today. We need courage."

As he spoke, scores of demonstrators lined the suburban highway leading to Strongsville's Ehrnfelt Recreation and Senior Center, waving signs denouncing the health care proposal. Among the hand-painted, critical slogans: "Kill the Bill," and "Just Say No to Obamacare."

One demonstrator held aloft a sign with the now classic Shepard Fairey image of the president, emblazoned with the word, "Communist."

Inside, Mr. Obama renewed his argument with the legislation's critics, in Congress and on the streets.

"Now, the opponents of reform, they've tried to make a lot of different arguments to stop these changes," he said. "You remember. First, they said, 'Well, there's a government takeover of health care.'

"Well, that wasn't true ... Then they said, 'well, what about death panels?' Well, that didn't turn out to be true."

Later, drawing laughter from the crowd, he said, "I know we've got some seniors here with us today -- I couldn't tell; you guys look great; I wouldn't have guessed."

Addressing what he called "the most insidious argument," against the legislation, he said, "I want to tell you directly: This proposal adds almost a decade of solvency to Medicare ... This proposal makes Medicare stronger, makes the coverage better, and makes its finances more secure," Mr. Obama said. "Anyone who says otherwise is either misinformed -- or is trying to misinform you."

Turning to critics of the measure's cost, Mr. Obama said that the changes would bring down the deficit. He contrasted his approach with the Medicare prescription measure enacted in the last administration.

"Now they're up there on their high horse," he said of congressional Republicans. "Their plan expanded the deficit."

Mr. Obama also told the crowd that the tax credits to be offered to those who cannot afford insurance in the new private marketplace the legislation would create would amount to "the largest middle-class tax cut for health care in history."

Like his appearance last week at Arcadia University in suburban Philadelphia, Mr. Obama's sights were aimed beyond his supporters.

Traveling with the president on Air Force One was Rep. Dennis Kucinich. The event in this affluent Cleveland suburb was in Mr. Kucinich's congressional district, but more to the point of this crucial week, he has been one of the most outspoken Democratic holdouts on the latest version of the health care legislation. While critics from the right have characterized the legislation as too expensive, the former long-shot presidential candidate, a long-standing advocate of a single-payer heath care system, has criticized the current legislation as a giveaway to insurance companies.

As Mr. Obama introduced the local congressman, the cry, "Vote yes," came from the crowd.

"Did you hear that, Dennis?" said a smiling Mr. Obama.

Across the state, Vice President Joe Biden was appearing at a Cincinnati fundraiser for another Ohio lawmaker undecided on the health care vote, Rep. Steve Driehaus.

Another Ohio congressman, Rep. John Boehner, the Republican leader, said that his caucus would "do everything we can to make it difficult for them, if not impossible, to pass the bill."

As the president spoke here, the House Budget Committee was poised to vote on the reconciliation package that was to make a variety of changes to the version of the health care bill passed earlier in the Senate. Leaders said a vote by the full House could come by the weekend.

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