Doctors' group backs cap on health-care spending

September 15, 1992|By Robert Pear | Robert Pear,New York Times News Service

WASHINGTON -- The American College of Physicians, the largest medical specialty group in the United States, said yesterday that there should be an overall national limit on health-care spending, with new restrictions on the amounts charged by doctors and hospitals.

The proposal signals a turning point in the debate over the future of the U.S. health-care system because it indicates that significant numbers of doctors now support an approach favored by many labor unions, big businesses and Democratic members of Congress.

Under the proposal, all employers would be required to provide health insurance for their workers or to pay a new tax to finance a national public health plan in which the employees could enroll. Private and public health insurers would offer a uniform set of benefits, covering "all medically effective and appropriate care." Hospitals and doctors would negotiate payment schedules with insurers and others who pay for their services.

Gov. Bill Clinton of Arkansas, the Democratic presidential nominee, also favors a comprehensive budget for all health-care spending, public and private alike. President Bush vehemently opposes the idea, saying it will lead to stringent rationing of health care, and he regularly denounces the idea in campaign speeches.

The college, second-largest physicians' group, has 77,000 doctors who specialize in internal medicine. It unveiled the proposal yesterday in its journal, the Annals of Internal Medicine.

Historically, doctors have opposed efforts by government, insurers and businesses to regulate their fees. But Dr. Willis C. Maddrey, president of the American College of Physicians, said, "Today we acknowledge that times have changed."

"The health-care system is so broken that something much greater than incremental reform must be done to fix it," Dr. Maddrey said at a news conference.

The plan goes further than the nation's largest physician group, the 300,000-member American Medical Association, which wants to require employers to provide health insurance for employees but does not support a national health-care budget with limits on doctors' fees.

In developing the plan, the college's 28-member board consulted a wide range of business and labor groups and questioned college members.

The plan did not say exactly how it would calculate the national health budget. But it said that current spending on health care, $800 billion, or 14 percent of the gross domestic product, was enough for this year.

Under the college's plan, doctors and hospitals would negotiate fees with insurance companies and other payers, setting uniform rates in a state or an area within a state.

"All payers would pay the same price for the same service," the college said.

The plan suggested that state officials would develop a health-care budget for each state. And Dr. John R. Ball, executive vice president of the college, said the medical profession would police the new limits on spending and doctors' fees.

While requiring employers to buy health insurance for employees, the college would lighten the burden in three ways. If employers chose to provide private insurance, they would not have to cover retirees or employees 60 years old and over, and they would not have to pay catastrophic costs, defined as those exceeding $50,000 a year for one person. The new publicly sponsored health program, consolidating Medicare and Medicaid, would pay such costs.

These elements of the college's proposal address Mr. Bush's concern that new federal mandates for health insurance would impose a crushing burden on small businesses.

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