Doctors may fight health care reform Seeking to be heard, AMA threatens to 'go to war'

March 01, 1993|By John Fairhall | John Fairhall,Washington Bureau

WASHINGTON -- Furious at the White House for considering health care reforms that would cut physicians' incomes, the nation's most powerful doctors' group is urging the administration to make patients share the burden through a tax on health benefits.

The American Medical Association, which finds itself relegated to the sidelines as a White House task force debates health care reform, is warning of a possible "war" with the Clinton administration if its views are not heeded.

Accustomed to being listened to in Washington, the AMA is fighting proposals being studied by the task force that would impose tough, short-term controls to contain runaway medical costs. Among those being considered are caps on the income of doctors, hospitals and insurance companies.

All these industry groups have been excluded from representation on the task force. But they have been invited to meetings with task force leaders, who have challenged the groups to propose alternatives to cost controls to help finance benefits for 35 million uninsured Americans.

Although hospitals and insurers have refrained from strong criticism as they try to influence the task force, the AMA -- one of the top contributors to congressional campaigns -- is increasingly confrontational. This month, the organization is asking physicians to gather in Washington to gain a stronger voice in the shaping of a reform program President Clinton has promised to deliver by May 1.

"We're inviting any physician in the country to come who wants to come," Dr. James S. Todd, AMA executive vice president, said Friday. "It's something we've never done before. But we think the times are critical and that the public, the administration and Congress need to realize that physicians are very concerned about their ability to continue to provide the kind of care that Americans are used to."

Referring to cost controls, Dr. Todd said, "I think we're going to have trouble with something that only affects the profession and doesn't involve patients. If the president is asking for restraint, he needs to get restraint from all segments of society."

He warned that if there is no "shared sacrifice," the AMA might "go to war." He did not elaborate on what the AMA might do to oppose the administration's proposals.

Other steps the AMA is asking the administration to take include reforms in insurance, streamlining of billing, changes in liability laws to protect the medical profession against unjustified lawsuits -- "a whole series of things that aren't just economic hammers" on the profession, Dr. Todd said.

A tax on employee health benefits, which polls show the public strongly opposes, has lost favor within the task force headed by Hillary Rodham Clinton. Instead, it is looking at more lucrative and politically attractive means of curtailing medical spending and generating revenues, namely cost controls and possibly taxes on insurers, hospitals and doctors.

Although insurers and hospitals strongly object to such controls, saying as doctors do that they do not solve underlying causes of medical cost inflation, they have been more conciliatory.

The Health Insurance Association of America, representing commercial insurers, has abandoned a once-rigid position opposing federally directed health reform. In another switch that could cost the industry money, it no longer opposes taxation of employee health benefits, something that would effectively make insurance more expensive.

There is enormous pressure to compromise, for the alternative is to risk being cut out altogether from the reform effort. Gordon Wheeler, a lobbyist for the insurance association, sums it up this way: "Something is going to happen. You have an option: You can participate or not."

Bill Gradison, the association's president, was challenged last week, in a meeting with presidential adviser Ira Magaziner, to come up with fresh ideas for restraining medical expenditures, particularly in the short run.

The administration does not want to wait several years for savings from a long-term structural overhaul of the health system being developed by the task force. Without immediate savings, which cost controls would provide, there would be little chance of quickly phasing in universal medical coverage. The economy also would suffer.

Mr. Gradison has asked member insurance companies to respond with ideas. In a letter mailed Thursday to them, he said Mr. Magaziner asked for written proposals in two weeks on "interim steps that could be taken to decrease health care cost inflation from 11 percent to 5 percent."

Mr. Gradison wrote that the meeting with Mr. Magaziner "was positive and constructive in every way," but he also noted that the insurance group remained committed to reform that included "maximum participation of private health insurance."

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