Doctors Try to Shape Clinton's Program to Reform Health Care

THE American Medical Association, under pressure from the Clinton administration's health care reform task force, is considering asking its 290,000 members to voluntarily control their costs.

Ira Magaziner, one of the president's domestic policy aides, reportedly told the American Medical Association's (AMA) board of trustees on Wednesday that the administration is considering a plan to freeze health care costs, which hit $1 trillion last year. Health care providers could show good faith by voluntarily limiting their prices, Mr. Magaziner said.

"It is something we are thinking about, and I think there may be some merit to it, but the board has not made a final decision on it yet," said Dr. Raymond Scalettar, chairman of the AMA's board of trustees.

Besides imposing an across-the-board freeze, the administration is also looking at several other short-term plans to reform health care - including a cap on health-insurance premiums and extending Medicare's regulated payment system into the private sector. One of these measures will probably be included in the comprehensive health-reform proposal that will be unveiled by Hillary Rodham Clinton on May 3.

In recent weeks, doctors, as well as other health care providers, have complained that they were being excluded from the deliberations of Mrs. Clinton's task force on health care reform. In early March, the first lady said that no "special interests" would get a seat at the table. On Wednesday, Dr. Scallater shot back: "We never sought a seat at the table. We sought a dialogue."

Administration officials apparently have heeded the call. Even before the task force holds its first public hearings Monday, leading administration spokesman addressed 1,000 AMA members who gathered here Wednesday and Thursday to lobby the legislative and executive branches.

Vice President Al Gore Jr. told the AMA: "We cannot and do not want to build a better health care system without the cooperation and leadership of the AMA. But the days when one association, no matter how prestigious, can dominate the health reform debate, are over."

Mr. Gore said that the administration would ask the AMA to help control skyrocketing costs and, in exchange, the government would reform the malpractice liability system, cut bureaucracy, and reduce paper work - steps the doctors favor.

Other Democrats who spoke to the meeting included Sens. Jay Rockefeller of West Virginia and Edward Kennedy of Massachusetts. They were greeted with polite applause. At one point, however, Senator Rockefeller said that President Clinton was elected by a large majority and audience members shouted back, "No! No! No!" Later, Health and Human Services Secretary Donna Shalala gave a brief speech and refused to take questions from the audience. She departed the room to a cascade of hisses from the doctors.

By contrast, speakers who criticized the administration's health-reform plans - including Sens. Bob Dole (R) of Kansas and Phil Gramm (R) of Texas - received thunderous applause.

DESPITE their warm reception for administration critics, the doctors are backing a "managed competition plan," which has been endorsed by President Clinton and may form the basis of Mrs. Clinton's reform package.

Under managed competition, Americans would join large buying groups, which would purchase insurance en masse from managed-care companies, such as health-management organizations. The buying power of these large groups theoretically would hold costs down, and the managed-care companies would compete for contracts.

What the AMA is concerned about is a managed competition system that has a "global budget" limiting how much the nation spends on health care.

"Traveling this country, I've run into a great many agitated, unhappy, frightened physicians.... Some are very strident," says Dr. James Clowe, the AMA president.

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