Republican presidential candidate Mitt Romney on Tuesday called for placing a cap on medical malpractice lawsuits, a point that drew loud applause at an Iowa medical school. Romney focused on health care in an address to some 500 students and faculty at Des Moines University. As governor of Massachusetts, Romney pushed through a plan aimed at reducing the ranks of uninsured in Massachusetts, a group once estimated at up to 500,000. Massachusetts residents had until last Thursday to sign up for health insurance or face possible penalties - a milestone Romney's rivals gleefully noted. "I believe we have to enact federal caps on non-economic and punitive damages related to malpractice," Romney said. "These lottery-sized awards and frivolous lawsuits may enrich the trial lawyers but they put a heavy burden on doctors, hospitals and, of course through defensive medicine, they put a burden on the entire health care system."

Romney also would encourage states to create health courts with judges experienced in handling medical liability cases and would ask states to adopt sanctions against lawyers and others who repeatedly file frivolous malpractice claims.

"We've got to reign in the incessant cost of medical liability," he said.

Romney, who once held a double-digit lead in Iowa, seemed to lower expectations in the Jan. 3 caucus state now that his lead over Mike Huckabee has narrowed.

"Now other folks are coming in with their ads and getting out and as a result, it's going to tighten up," he said. "I can't tell you how it's going to turn out but I sure plan on being in the top three in Iowa and New Hampshire but if I can win one that would be great, but if I can be in the top two in both that would be great as well."

Romney's health plan as presidential candidate focuses on a federalist approach in which states craft their own programs.

At one point, Romney joked about the "teeth" of failing to sign up in Massachusetts.

"If you don't have insurance you get charged $100 on your tax bill," he said. "So people are going to start buying insurance."

Later, he told reporters the carrot-and-stick approach is necessary to get people to take responsibility for their own health care costs.

"It's a recognition that people have a responsibility if they can afford insurance to either buy insurance or pay their own way," he said. "It's the ultimate conservative view that people have the responsibility to care for themselves and not to look to government to care for them."

Answering reporter questions after his presentation, Romney said Democratic front-runner Hillary Rodham Clinton's approach to health care focuses on expanding government programs and spending more than $100 billion more.

"My approach is based on the free enterprise system and personal responsibility and hers is based on government," Romney said. "Government reliance is not a conservative principal and that's what exists throughout the country except now in Massachusetts."

Written By DAVID PITT