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.
The AMA put caveats on some of these items and repeated its opposition to other items under White House discussion, including the proposal for a "global budget" that would set a strict limit on the amount the nation spends on health care.
But the AMA did offer to support a cap plan, probably less restrictive than the global-budget approach, under which doctors would accept national or regional health care spending limits if they can help set them.
Robert Boorstin, a White House spokesman on health care, said yesterday that the White House "welcomes the participation of the AMA, as we always have" and said that the AMA shift showed that a "consensus is being formed that there has to be immediate change, and that it is coalescing around the principles that the president's plan is being built on."
An AMA spokesman yesterday said that it is a "reasonable reading of the proposal" to say that the overall spending limits would be at the level of inflation in the rest of the economy. Last year, that was 2.9 percent, while inflation for doctors' fees and other medical costs was 6.6 percent.
In return for its concessions, the AMA is asking that practicing doctors be represented on the White House health care group and consideration of a number of proposals, including curbs on malpractice suits, assurance that some patients will still be able to choose doctors freely and some antitrust relief so doctors can negotiate fees with any government board setting budgets.
The letter to Mr. Magaziner marks a "major change, a quite different approach for the AMA," said one association spokesman.
It was an especially significant shift for an organization that has been credited with killing a number of health care proposals in the past.
The AMA, with its more than 290,000 members and its lobbying budget of tens of millions of dollars, could have posed a substantial obstacle to a Clinton package, and its support could add momentum to attempts to press the package both before the public and in Congress.
In the past, the AMA and allied doctors have been credited with killing health insurance proposals in the administration of Franklin D. Roosevelt, defeating President Harry S. Truman's national health program and halting President Jimmy Carter's hospital cost containment measures.
But in the new climate in Washington, according to various AMA officials, the group worried that it was being left behind as Democrats on Capitol Hill, other medical organizations and such health industry stalwarts as the Pharmaceutical Manufacturers Association have embraced "managed competition" and some limits on price increases.
The AMA proposal was delivered to the White House yesterday, after last-minute changes were made Tuesday night to back away from some more specific proposals, such as expressing a willingness to freeze fees for a short time if asked by the administration.
The letter offered to join in the "shared sacrifice" the will be made by others in health care when the final proposals for change are made in May. It said that the AMA proposes a "new partnership" with the government.
"We know that status quo must go," wrote the AMA executive vice president, Dr. James S. Todd, but he also warned the White House that doctors have so far been excluded from shaping the new package and that "any reform system will fail without the support of the profession."
The principal elements of the administration package include keeping costs down, reforming insurance rules, letting people choose their doctors and keeping the quality of health care high, Mr. Boorstin said.
The AMA's offer is widely seen as an attempt to try to regain leadership among the medical groups. Others have been quicker to support some of the Clinton proposals, most notably the American College of Physicians last fall.
In addition, the American Academy of Family Physicians and the American Nurses Association have led the way with offers to support a ceiling on medical spending imposed by the government or a national health board.
Many doctors have been the beneficiaries of huge pay increases and realize that they are likely to be targets for anger and budget-cutting if they do not offer to make sacrifices.
Between 1983 and 1991, the mean income of doctors has gone from $88,000 to $170,000 per year, according to the AMA's own figures. The lowest-paid doctors are family physicians, making $111,000 per year; the highest are surgeons, at $234,000 per year.
The AMA, along with many other, much smaller medical groups, has been invited to make presentations to the White House but has not been privy to any of the work of fashioning a health care plan, which is due in May.