Pirated health plan texts spark debate AMA, others seize upon details in photocopied draft

September 12, 1993|By John Fairhall | John Fairhall,Washington Bureau

WASHINGTON -- Armed with pirated copies of President Clinton's confidential health care reform plan, critics are taking early shots at his sweeping proposal for restructuring the nation's health system.

The 239-page document outlines new federal and state regulatory powers over the financing of health care, the benefits people receive and those who provide the benefits: doctors, hospitals and insurers.

A new National Health Board would sit atop the system. State governments and regional "health alliances" -- insurance purchasing organizations -- would exercise considerable authority, dictating terms to insurers, doctors and hospitals, according to the document, a copy of which was obtained by The Sun.

White House officials had hoped to limit circulation of the document so that they could control release of information about the plan -- and build support for it -- in the days leading up to the president's formal announcement Sept. 22.

But now hundreds of photocopies of the document are circulating, giving lobbyists for health care interests and congressional foes a head start on attacking it.

Among the groups preparing their case is the powerful American Medical Association, which opposes the administration's malpractice reform proposal because it doesn't limit the size of awards consumers can win from physicians.

The AMA will try to change the president's thinking before he releases a final version of the plan later this month.

"We're going to see Dr. [Ira] Magaziner next week," an AMA spokesman said yesterday, referring to the man who coordinated development of the plan under the direction of Hillary Rodham Clinton, who headed the presidential health care task force.

On Capitol Hill, unhappy conservative lawmakers, such as Rep. Jim Cooper, a Tennessee Democrat, are speaking out.

"The Clinton plan has a distressing amount of government trying run things," Mr. Cooper said, expressing a view many Republicans are also embracing.

Meanwhile, liberals are unhappy about the White House plan to pay for the reform by limiting the growth in Medicare and Medicaid spending and the states' ability to go on their own.

White House officials, though angry about the premature release of the plan, insist it isn't much of a problem.

"We know where the enemies are, and we know what attacking points they have selected because they're already out there," said spokesman Kevin Anderson, noting criticism of the proposal that all employers provide insurance.

He termed the document an unpolished draft undergoing revision.

President Clinton is expected to formally unveil the health plan in a speech to Congress on Sept. 22.

The reception of the administration's plan has not been all negative. Fifty state directors and board members of Citizen Action, an advocacy group pushing for a single-payer system, met at the White House with Mrs. Clinton yesterday and expressed qualified support for the plan.

Many of the key features of the plan -- such as the proposed employer insurance mandate -- have already been published, based on selected information from the plan that administration officials provided to reporters in recent weeks.

Blueprint for intervention

But viewed at as a whole, the document seems to be a blueprint for unprecedented government intervention in the health care marketplace.

Acting in the belief that the present health system squanders money and is stacked against the public, the Clinton administration proposes to use federal and state government authority to empower consumers and employers.

The new National Health Board, consisting of seven members appointed by the president and confirmed by the Senate, would help calculate state-by-state budgets for health care spending -- ceilings which states could not exceed.

Health care budget-setting, never tried in the United States, is one of two powerful regulatory tools the administration would use to control the skyrocketing cost of health care, now one-seventh of the U.S. economy and growing rapidly. The other tool is a ceiling on annual increases in medical premiums charged by private insurers.

Both ideas appall free-market advocates, like the conservative Representative Cooper, who terms them "back-door price controls."

The national board also "establishes and manages a performance-based system of quality management and improvement," the document states. To help it measure quality, the board will develop standards for a new "national health information system."

Consumers, who would get a medical identification card similar to a bank ATM card, would eventually receive some sort of annual report that graded the performance of each of the health plans competing for their business.

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