In an important break with the past, the nation's secon largest medical society has called for a major overhaul of the U.S. health care system, including placing a cap on health spending and putting "realistic" limits on doctors' fees.
lTC Under the proposal, announced yesterday by the American College of Physicians at a briefing in Washington, Americans would be guaranteed the same level of benefits regardless of whether they have private or employer-based insurance, or have their medical bills paid by government.
The estimated 36 million Americans who have no health insurance would, under the ACP plan, be covered by government-financed insurance. According to the ACP, the uninsured often delay going to the doctor or do not obtain care at all.
To pay for its proposal, the Philadelphia-based ACP calls for consolidating all existing public programs into a single plan. It would also make a variety of changes to eliminate unnecessary procedures and tests, often ordered to minimize potential legal liability, and an overemphasis on costly but unproven high-tech procedures.
The ACP represents 77,000 internists nationwide; there are 270,000 physicians, including many other kinds of specialists, in the American Medical Association.
The ACP's tacit acceptance that there must be national limits on medical spending represents a fundamental break with other organized medical groups, including the AMA, which have essentially called for maintaining the existing system but expanding coverage through a series of public and private taxes.
Dr. John R. Ball, the group's executive vice president, estimated that these and other steps could bring $100 billion to $150 billion annually in savings, money that could fund a reformed system with the same benefits for all Americans, whether they had private or publicly funded health insurance.
"The bottom line is we say there is enough waste and inappropriate usage in the existing $800 billion system to be redistributed to finance these changes," Dr. Ball said. "That's the starting point for setting a budget. Let's first look at what we have in the existing system before we look at whether additional funds are needed."
The proposal comes at a time of growing concern in Congress and among business and labor leaders over the spiraling costs and fragmented nature of the U.S. health care system. ACP officials acknowledged that some elements of the plan are similar to the health care system proposed by Arkansas Gov. Bill Clinton in his campaign for the presidency.
A White House adviser on health issues said the ACP proposal was unacceptable. "It is absolutely contrary to what we are doing," said Gail Wilensky.
Among the changes called for by the ACP are:
* A U.S. health care budget developed by a national commission and approved by Congress. The commission would be responsible for setting limits for spending by public and private insurers and reviewing new technology and society's changing medical needs.
* The consolidation of Medicare, Medicaid and various other publicly financed health programs into a single public system. This new entity would pay the bills for all Americans not belonging to private plans. However, these individuals would be free to join any of a multitude of insurance plans, HMOs or other groups.
* Regulation of the supply of doctors and hospitals, as well as limits on provider fees. Under the ACP plan, doctors, hospitals and other
medical providers would negotiate fees with states. Once set, all insurers would then pay the same fee for a given procedure. This would be a radical departure from current payment systems for doctors, which are inherently inflationary and contain few cost controls.