First lady reassures doctors She outlines deals to win their support, such as suit limits

June 14, 1993|By Robert Pear | Robert Pear,New York Times News Service

CHICAGO -- Hillary Rodham Clinton yesterday proposed "a new bargain" with the nation's physicians in which the White House would limit malpractice lawsuits, relax regulation of medical laboratories and free doctors from burdensome government supervision if doctors supported President Clinton's effort to overhaul the nation's health care system.

In a speech to the American Medical Association, Mrs. Clinton said doctors must take the lead in cracking down on incompetence, negligence and other abuses by practicing physicians.

In return, she said, the administration would try to protect the "clinical autonomy" of doctors, reduce paperwork and remove legal obstacles to self-regulation of the medical profession.

Speaking to an audience of more than 3,000 at the annual meeting of the AMA in Chicago, Mrs. Clinton said doctors could not regain "trust and respect and professionalism" without completely changing the operation and structure of the nation's health care system.

She told the doctors what they wanted to hear on many issues, including medical malpractice, but generally avoided issues on which the administration disagreed with the association.

The organization, for example, opposes President Clinton's plan to establish national limits on all health care spending, public and private, and is deeply concerned about various price controls that have been considered by the White House.

"Over the last decade," Mrs. Clinton said, "our health care system has been under extraordinary stress. That stress has begun to break down many of the relationships that stand at the core of the health-care system. That breakdown has, in turn, undermined your profession in many ways, changing the nature and rewards of practicing medicine."

'Work harder to renew trust'

Accordingly, Mrs. Clinton said, "we have to work harder to renew trust in who doctors are and what doctors do."

Mrs. Clinton is head of the President's Task Force on National Health Care Reform, which was originally supposed to develop a legislative proposal by May 3 to control health costs and guarantee insurance coverage for all Americans.

The plan, now expected sometime before the end of September, has been delayed by the complexity of the work and by the fact that Mr. Clinton has been preoccupied with the politics of budget legislation now pending in Congress.

Mrs. Clinton did not say how the administration would pay for its proposals. But she did say, "We will try to include prescription drugs in the comprehensive benefit package for all Americans, including those over 65 on Medicare."

She also tried to allay doctors' concerns that President Clinton wanted the United States to follow other countries where the government plays a larger role in medicine.

"We have looked at every other system in the world," Mrs. Clinton said. "We have concluded that what is needed is an American solution for an American problem, by creating an American health care system that works for America."

Doctors to have option

Under the president's plan, she said, patients would be able to choose their doctors, and doctors would be able to choose the health plans for which they worked. In addition, she said, doctors would have "the option of being part of more than one plan at the same time," even though the health plans will compete with one another.

Mrs. Clinton expressed sympathy for members of her audience. "I know that many of you feel that as doctors you are under siege in the current system," she said. "And I think there is cause for you to believe that, because we are witnessing a disturbing assault on the doctor-patient relationship."

Mrs. Clinton received warm applause when she said, "I can understand how many of you must feel when instead of being trusted for your expertise, you are expected to call an 800 number and get approval for even basic medical procedures from a total stranger."

'Excessive oversight'

She added: "The result of this excessive oversight, this peering over all of your shoulders, is a system of backward incentives. It rewards providers for over-prescribing, over-testing and generally overdoing, and it punishes doctors who show proper restraint and exercise their professional judgment in ways that those sitting at the computers disagree with."

Mrs. Clinton did not attack price gouging and profiteering in the health care industry, as she did in a speech to a labor union on May 26. Rather, she pleaded with doctors to forge "a new bargain" with her.

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