Critics of health plan put White House on defensive


WASHINGTON -- Fighting doubts and fears that many Americans have about the president's health care plan, a top White House aide insisted yesterday that it will "increase choices" for consumers and put them "in the driver's seat."

Ira Magaziner, who coordinated the work of the presidential task force headed by Hillary Rodham Clinton, spoke to reporters at a rare Sunday White House briefing called to counter attacks by critics who are "misstating the facts."

The White House is being put on the defensive by charges that it would harm consumers by limiting their choices and damaging quality of care, and particularly harm the elderly and poor by extracting savings from the Medicare and Medicaid health programs.

Dr. Nancy Dickey, a trustee of the American Medical Association, said on ABC's "This Week with David Brinkley" yesterday that President Clinton's plan appears to emphasize cost savings "before patient care."

These attacks, by special interest groups as well as some lawmakers, threaten to compound already substantial public anxiety about the plan that Mr. Clinton will formally unveil Sept. 22.

More Americans expect Mr. Clinton's plan to hurt rather than help their families, according to a new U.S. News & World Report poll done jointly by Republican and Democratic pollsters. While only 33 percent said it would help, 37 percent said it would hurt.

Such doubts mean the administration has a long way to go to convince the public that its plan is good for America. What concerns people, this and other polls showed, is that they will have less choice than they do now, quality will drop and personal health care costs will rise.

Mr. Magziner also said that the administration will not alter its proposal to save money from future Medicare spending to help finance national health coverage. The administration insists that the health plan can cap the growth of Medicare outlays without hurting the quality of the program that serves 33 million Americans over the age of 65 and 3 million disabled individuals of all ages.

"Our cost and savings projections are solid, and we stand firmly behind them," Mr. Magaziner said. "They are conservative and ++ credible."

The health plan calls for Medicare and Medicaid to provide $238 billion of the $441 billion needed over the next six years for the reform program.

The Medicare numbers could be revised slightly, as could the amount of revenue collected from "sin" taxes on alcohol and tobacco, Mr. Magaziner said. But the major thrust -- big savings from Medicare and Medicaid -- will not be changed, he said.

In a speech Friday, Mrs. Clinton noted that employers, seeking to control health care costs, are limiting the choice of health care plans that workers have. In the Clinton plan, however, consumers purportedly would have more authority to choose their plans and dictate terms to insurers, hospitals and doctors.

The plan would create insurance purchasing organizations ostensibly run by and for consumers and employers. These "health alliances" would demand competitive bids from insurers and health care providers.

The insurance industry charges that the alliances would sharply limit the number of plans permitted to provide coverage, effectively limiting choice. But a draft of the Clinton plan states otherwise, saying that with few exceptions, the alliance could not turn away any plan that met its requirements.

Supporters of the administration plan hail this feature.

"Insurance companies no longer can drop you," said Arnold Bennett, spokesman for Families USA, a consumer group that has worked closely with the administration on health care reform. "But you have an increased right to drop them."

"Choice of health plan is increased for most Americans who right now have to take largely what their employers give them," he added. "Under the new system everyone will be able to choose among plans and choose among their doctors."

The Clinton plan specifically guarantees that each alliance would offer at least one plan permitting broad freedom to select doctors. But this kind of plan would probably cost a consumer more than a health maintenance organization would, administration officials say, citing the cost-control advantages that HMOs have generally demonstrated.

Additionally, the plan would enhance consumers' choices by giving them more information than they have now about the quality and performance of HMOs, doctors and hospitals. Alliances would help collect and distribute this information about competing health plans, the Clinton plan states.

But critics of the Clinton plan say it would limit choices. Stuart M. Butler, a vice president of the conservative Heritage Foundation, said administration officials are "talking about choices within a very narrow band of services," those specifically mandated by ,, the government.

"You're not talking about people going out and saying 'I want more of this particular service and less of that,' " Mr. Butler said.

The Clinton plan would set spending limits on health care in each state and limit the amount insurance premiums can increase annually. Detractors like Mr. Butler say these are tantamount to price controls on services.

Mr. Magaziner, however, called such claims "scare tactics" and "nonsense."

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