Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, June 14, 1993 TAG: 9306140175
SECTION: NATIONAL/INTERNATIONAL PAGE: A-1 EDITION: METRO
SOURCE: The New York Times
DATELINE: CHICAGO LENGTH: Long
Hillary 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 at the annual meeting of the AMA in Chicago, 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 Clinton disagreed with the association.
The organization, for example, opposes Clinton's plan to establish national limits on all health-care spending, public and private, and is deeply concerned about price controls that have been considered by the White House.
"Over the last decade," 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."
Accordingly, Clinton said, "we have to work harder to renew trust in who doctors are and what doctors do."
Clinton was head of the President's Task Force on National Health Care Reform, which was supposed to develop a legislative proposal to control health costs and guarantee insurance coverage for all Americans. The plan, expected before the end of September, has been delayed by the complexity of the work and by the fact that President Clinton has been preoccupied with the politics of budget legislation pending in Congress.
Hillary 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 the Clinton administration wanted the United States to follow Canada, Germany or other countries where the government plays a larger role in medicine.
"We have looked at every other system in the world," she 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."
Under the administration'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.
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."
She 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."
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."
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.
"We need to remove from the vast majority of physicians these unnecessary, repetitive, often unread forms and instead substitute more discipline, more peer review, more careful scrutiny of your colleagues," Clinton said. "Let us remove the kind of micromanagement and regulation that has not improved quality and has wasted billions of dollars."
Specifically, Clinton said, "We have to simplify and eliminate the burdensome regulations" imposed on medical laboratories. Congress required such regulations several years ago after federal investigators found that some laboratories were failing to detect clear evidence of cancer and other deadly diseases. But doctors have asserted that they will be unable to perform certain lab tests in their offices under the new rules, so patients will suffer.
As part of the new bargain, Clinton said, "We will offer a serious proposal to curb malpractice problems." She did not give details. But White House officials said they were considering proposals that would require arbitration of claims and would limit payments to victims of malpractice and their lawyers. The limits would apply, in particular, to damages for "pain and suffering" caused by a doctor's negligence.
In an interview, consumer advocate Ralph Nader denounced these proposals.
"They will alienate grass-roots citizen groups that [President] Clinton was counting on to support his overall health-care plan," Nader said. "These malpractice proposals would strip vulnerable patients of the meager rights they have now, and the proposals will depreciate Hillary Clinton's most important asset: knowledgeable compassion for consumers."
by CNB