AMA will work on health reform while fighting it

WASHINGTON — WASHINGTON -- The American Medical Association reassured key lawmakers yesterday that it will stay at the bargaining table on national health insurance, but AMA officials emphasized that they still have several objections to President Clinton's proposals.

James S. Todd, the AMA's executive vice president, told a Senate panel that Mr. Clinton's health plan should be changed to include bigger caps on malpractice awards and fewer restrictions on doctors' fees.


During the Senate hearing, Sen. Edward M. Kennedy tried to minimize the differences between the doctors' association and the administration.

"Will these concerns keep you from working with the president and Congress?" asked the Massachusetts Democrat, who is pushing the Clinton plan on Capitol Hill.


"Absolutely not," Mr. Todd responded. "The time for reform is now."

But in his testimony, Mr. Todd clearly signaled the AMA's intention to continue to press for several major changes in the president's proposal. Last week, the AMA sent a mailing to 670,000 doctors and 40,000 medical students urging them to lobby against parts of the plan.

Chief among the AMA's objections are cost-control mechanisms in the plan that doctors fear would force them to pick the cheapest rather than the best treatment in some cases. Patient treatment plans would in effect be made in Washington rather than in the consulting room, the AMA fears.

Instead of trying to save money through "arbitrary" spending caps, the AMA suggests that the government cut costs by limiting the amount of malpractice awards to $250,000. Lower malpractice awards would mean lower insurance rates for doctors and result in lower fees, the AMA argues.

Mr. Todd added that the AMA might be willing to support spending limits if physicians had a role in setting the budget, and if the budget targets were flexible.

Mr. Kennedy chairs the Labor and Human Resources Committee, which has major jurisdiction over the administration plan.