Health Care

WASHINGTON -- Nurses, historically relegated to a secondar status in the world of medicine, would assume a more significant, independent role in providing health care under the White House health-care plan, specialists and administration sources say.But doctors say they would fight efforts to give nurses more independence.The Clinton health plan, with its emphasis on preventive care, would call for greater reliance on services that nurses already are trained to perform. And a shortage of doctors who practice general medicine means highly trained nurses probably will be called upon in greater numbers when the government offers health care to the nation's 37 million uninsured.

WASHINGTON -- Health-care spending in the United States will nearly double over the next decade to $4.1 trillion in 2016, government economists said yesterday, prompting concern that Americans cannot keep paying increases that outstrip the growth of the economy. The health-care bill will average $12,782 for every man, woman and child in 2016, an increase from $7,498 this year, said the report, published online by the policy journal Health Affairs. Health-care costs will account for nearly 20 cents out of every dollar that Americans spend in 2016, up from about 16 cents today.

What a difference a few months can make!At the end of 1991, health/biotechnology funds were riding high, having achieved an average total return of 74.3 percent for the year, according to Lipper Analytical Services.Oppenheimer Global Bio-Tech Fund had led the group with a phenomenal 121 percent return, while even the year's laggard, Vanguard's Health Care Portfolio, had topped 46 percent, far ahead of the 30.5 percent return for the Standard & Poor's 500 Index.Now, with the broad stock market, as measured by the S&P 500, essentially where it was when 1992 began, the health-fund average is off more than 16 percent.

YOU CAN'T take politics out of health-care issues. Too much money is involved -- for patients, insurers and the government.In Washington, Republicans are jockeying with Democrats to gain advantage in passing a "patients bill of rights." Initially, GOP conservatives opposed this notion, but pressure from voters propelled them to offer a limited plan to give consumers in managed-care situations greater medical choices.In Maryland, politicians are playing a similar game. Democratic gubernatorial candidate Eileen M. Rehrmann wants to punish medical directors of health-maintenance organizations for denying treatment to patients.

ANNAPOLIS -- A House committee considered a bill yesterday that would practically ban the private health insurance industry from Maryland, put doctors on a strict annual budget and create a Canadian-style "universal" system.It was the first of three hearings in the House to examine the major health-care reform plans before the legislature this year. Most observers give those bills slim chance of becoming law this year, but supporters of the Canadian system think momentum for such a plan is building.

WASHINGTON -- Fearful of being left out of the debate on reshaping the nation's health-care system, the American Medical Association has told the White House that it will drop its long-held and formidable opposition to some proposals favored by President Clinton.In return, AMA officials said, they are asking for a seat at the table as the policy group led by Hillary Rodham Clinton works out what promise to be sweeping changes in medicine.In a letter sent yesterday to Ira Magaziner, Mrs. Clinton's right-hand man on health care, the group signaled its willingness to support the idea of "spending limits" on health care, to accept a National Health Board to review prices and practices in medicine and to accept that large "managed care" organizations, such as preferred-provider groups or health maintenance organizations, may be a large part of the health-care system in the future.

LAS VEGAS -- Sierra Health Services Inc. agreed to acquire Kaiser Permanente Group's Southwest division, a managed-health services business in the Dallas-Fort Worth area, bolster the managed-care company's Texas presence.Financial terms weren't disclosed for the transaction, which Kaiser said marks the first time the nonprofit organization has sold one of its operations.bTC The companies said they expect the acquisition, which needs to be approved by the two boards and by regulatory agencies, to be completed by Oct. 31.Kaiser's Southwest division includes 123,000 health plan members and 150 doctors.

ANNAPOLIS -- A House committee considered a bill yesterday that would practically ban the private health insurance industry from Maryland, put doctors on a strict annual budget and create a Canadian-style "universal" system.It was the first of three hearings in the House to examine the major health-care reform plans before the legislature this year. Most observers give those bills slim chance of becoming law this year, but supporters of the Canadian system think momentum for such a plan is building.

Helix Health System and Medlantic Healthcare Group are teaming to create one of the largest health-care systems in the country, aimed at generating business in the potentially lucrative suburbs in the Baltimore-Washington corridor.The two managed-care operations have chosen Columbia as the headquarters for their joint venture, to be called BWHealth. The name is yet another symbol of their interest in establishing a presence in the corridor, where neither has any operations now.That interest is driven largely by the demographics of Howard, Anne Arundel and Charles counties.

WASHINGTON -- As a key component of his administration's health-care plan, President Bush intends to call for significant changes in federal law that would make it easier for small businesses to obtain lower-priced health insurance for their employees.Administration officials say the proposed revisions of labor law and the tax code would encourage small businesses to band together, thereby gaining new bargaining power in what is now an often fruitless quest for affordable coverage.The officials say Bush will unveil the plan either in his State of the Union address on Jan. 28 or in the federal budget proposal that will follow.