White House explores health-care cost control Limits on malpractice-suit awards, doctors' fees are among the ideas

March 09, 1993|By New York Times News Service

WASHINGTON -- As part of their effort to control health costs, Clinton administration officials are considering asking Congress to impose restrictions on medical malpractice lawsuits and limits on doctors' fees.

PTC No decisions have been made. The proposals, under study by health policy experts at the White House, have not been endorsed by Mr. Clinton.

But confidential work papers from the President's Task Force on National Health Care Reform show that the administration is seriously considering many proposals to limit lawsuits and payments for injuries caused by doctors' negligence.

Doctors support many of the malpractice proposals, which grow out of the movement to curb liability lawsuits and are favored by such conservative critics of trial lawyers as former Vice President Dan Quayle. But doctors oppose the idea of fee limits being considered as an element of the plan that President Clinton will send Congress by May 1. The president has said he wants Congress to approve his proposals this year, but the legislation is sure to be complex and hotly debated.

A White House group studying medical malpractice says the current method of compensating injured patients and disciplining doctors "has produced only a litigation lottery."

Among the ideas under consideration, some of which have been tried at the state level, are these:

* Limit damages for a patient's "pain and suffering."

* Reduce damages to take account of any money the patient gets from insurance or workers' compensation.

* Allow doctors to make payments periodically, over a number of years, rather than in a lump sum.

* Encourage patients to settle claims through arbitration rather than court trials.

Supporters of such measures say they have produced benefits when tried in some states, particularly California.

In the context of major changes in the health-care system, the documents say, consumers "might accept some modification of their legally prescribed rights, some reduction in their potential financial recovery or some change in fact-finding procedures" in exchange for an assurance that they would be paid for injuries resulting from a doctor's treatment.

A White House official said Mr. Clinton was trying to balance concerns of doctors and trial lawyers.

The task force, headed by Hillary Rodham Clinton, has a staff of 300 to 400 people, divided into more than 30 committees. The panel studying malpractice is headed by Dr. Robert Berenson, a physician, and Kathleen Hastings, a lawyer and nurse. Dr. Berenson is a member of the Jackson Hole Group, an influential organization of health-care executives and policy analysts who are trying to mix free-market economics with government regulation in a strategy known as managed competition.

Work papers from the task force show the administration is considering a proposal that would give everybody access to at least one "free-choice plan." In such a plan, consumers could choose their doctors and pay a separate fee services.

Documents from the task force show that White House officials are considering stringent limits on doctors' fees as part of a long-range strategy to control costs. "Physician fees and hospital payment rates could be regulated in conjunction with a policy of encouraging managed competition," the staff says.

The documents show that the task force is considering a fee schedule similar to one used by Medicare.

Mrs. Clinton on health care reform:

On taxing middle-class Americans to pay for health care reforms:

"In terms of any broad, general, middle-class tax increase, it's just not going to happen."

On when health reform would be in place:

"As soon as possible is the time frame. The definition of 'possible' is what we're trying to work out now. Ideally, we would do it in the next two years."

On her role:

"I kind of view myself in some ways as a citizen representative.. ."

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