Angry Maryland doctors rallied outside the State House yesterday to protest proposed limits on how much they may charge, but ended up booing and heckling the chairman of a Senate committee who has been trying to shield them from such caps.
Nearly 100 doctors and family members braved a freezing wind to complain that their views are not being heard in this year's debate over health care reform.
"This bill will drive physicians out of the state," Dr. Ronald Sroka, a family practitioner from Crofton, yelled at Sen. Thomas P. O'Reilly, the Prince George's Democrat who chairs the Finance Committee. "We just want to be heard."
Mr. O'Reilly was corraled into speaking to the group by former Gov. Marvin Mandel, the state medical society's lobbyist, who spotted him walking by the rally. The senator said the nation's health care system was in a mess and that it was partially the doctors' fault, but he also blamed insurance companies, drug manufacturers and other special interests.
Nonetheless, the senator drew shouts and jeers from hecklers in the crowd.
"When you physicians call my office, just try not to be rude," Mr. O'Reilly finally retorted, then stormed off. The incident demonstrated the depth of tension developing over the legislature's efforts to control health care costs and make insurance more available. With barely three weeks to go before adjournment, lawmakers are questioning whether anything will pass this year despite support from the governor and the presiding officers of both houses.
At mid-session, it appeared possible Maryland might enact health insurance reform before the Clinton administration can even present its health care program to Congress.
The House of Delegates overwhelmingly approved House Bill 1359, which would require insurers to offer policies to small companies that often cannot get or afford insurance for their employees.
For those policies, the bill would prohibit insurers from setting premiums based on how often employees have been sick or injured in the past. It also would gradually eliminate the practice of denying insurance to people because of pre-existing medical conditions, such as diabetes or cancer. The policies would have to be issued to anyone who wants them and renewed upon demand.
The bill also would establish a new commission to collect data on physician and other non-hospital costs and would give the commission authority to impose limits on physician fees.
However, faced with growing -- albeit behind-the-scenes -- opposition from doctors, insurance companies and virtually every other segment of the health care industry, the measure landed in the Senate with a thud. At a hearing this week, group after group said they supported the House bill, "but only with amendments" that in many cases would defeat the bill's intent.
Then Mr. O'Reilly, a high-strung, 54-year-old Greenbelt lawyer with eye-catching white hair, complicated matters by dropping his own book-sized draft of legislation to overhaul Maryland's health care system into the laps of the other 10 members of his committee.
His plan contains some of the House provisions, such as requiring "community rated" insurance policies for small companies.
But it also would force employees of those companies into health maintenance organizations. Rather than creating one new commission, Mr. O'Reilly's plan would create four -- including one to control health care spending by keeping it all within some "global budget."
And it would establish practice protocols for physicians, what some doctors derisively call "cookbook medicine." These guidelines would outline the procedures physicians should follow when treating patients -- even when to discontinue life support for terminally ill patients. In exchange for following the protocols, Mr. O'Reilly's plan would offer doctors a legal defense against malpractice suits, considered a large contributor to high health care costs.
The plan would permit limits on doctors' fees, but only if other cost containment efforts fail.
To unload such a complex, even radical proposal so close to adjournment prompted most participants in this session's health care debate to speculate whether it was simply an arrogant power play to impose his personal view on health care reform -- or an intentional effort to sabotage all reform legislation this session.
Mr. O'Reilly said neither theory is true. Rather, he said he developed his own proposal because he felt the House effort was not comprehensive enough to be effective.
The long-awaited proposal, drafted in such secrecy it jokingly became known as the "Stealth Health" bill, is 110 pages long and was not even shown to members of his own committee until 9 p.m. Tuesday, the 64th day of the session, and then only after the panel had sat through eight mind-numbing hours of testimony on a variety of other health reform bills.
His own committee members seemed stunned. "Make it clear this is the chairman's bill, not the committee's," snapped Sen. Patricia Sher, D-Montgomery.
"If the Senate passes this, nothing will happen this session," one lobbyist predicted minutes after reviewing the plan.
Some House members immediately interpreted Mr. O'Reilly's action in the worst possible light, but declined to say so publicly for fear it might offend him or the Finance Committee. For years, the Finance Committee and the House Economic Matters Committee have feuded publicly, privately and philosophically over just such difficult issues.
Economic Matters Committee Chairman Casper R. Taylor Jr., an Allegany Democrat whose committee worked for weeks with labor and business, doctors, hospitals, insurers, HMOs and others to draft and re-draft House Bill 1359, had hoped Mr. O'Reilly's proposal would be similar enough that the two could somehow be merged. When he saw Mr. O'Reilly's amendments, however, it was hard for him to hide his disappointment.
"Until the Senate Finance Committee votes on something, I'm going to reserve any comments because it is all speculative," he said.