AMA Urges Care for All Workers : Health: Businesses would be required to provide medical insurance. Plan probably would require new taxes.

The American Medical Assn. unveiled a sweeping package for health care reform Wednesday that would require businesses to provide medical insurance to all workers, expand health care for the poor and limit malpractice lawsuits.

Funding of the 16-point plan would “almost certainly” require new taxes, said Dr. Alan Nelson, president of the AMA. Although AMA officials declined to put a total price tag on the plan, Nelson estimated that one aspect--expansion of federal health programs--could cost $30 billion annually. Other AMA officials privately estimated the potential costs at more than $60 billion.

Last year’s resounding repeal of a program to treat catastrophic illnesses among the elderly appeared to have dimmed prospects for expanded health care. However, the AMA’s plan is considered significant, particularly because of the group’s clout with Republicans.

On the Democratic side, Sen. Edward M. Kennedy (D-Mass.), chairman of the Labor and Human Resources Committee that oversees health issues, called the AMA report “just what the doctor ordered.”

The AMA plan, announced at a press conference, covered common ground with that of a congressional commission, which last Friday also called for expanded coverage for the poor and a slightly different form of mandated employer insurance. Unlike the commission, which proposed a government program for long-term care, the AMA instead called for tax incentives to encourage private insurance coverage of nursing home stays.

The congressional group--known as the Pepper Commission--came under fire for failing to say how it would raise the $66.2 billion its plan would cost the federal government.

Responding to that criticism, Nelson said: “The debate must be centered on what is needed and then deal with how to pay for it.”

Under the AMA plan, Medicaid would be extended to every individual below the poverty line. Now, the AMA said, Medicaid reaches only 40% of the poor. An estimated 31 million to 37 million Americans are uninsured.

The AMA plan also calls for Medicare to be taken off the federal budget and “pre-funded” in a special program to make sure it can pay for itself into the year 2030, when it is estimated that for every two workers, there will be one retired person relying on Medicare.

Otherwise, Nelson contends, the system faces bankruptcy by the year 2000.

Medicare would provide catastrophic care, to be funded by a combination of taxes on individuals and companies, under the AMA plan.

The House already is considering a package of Medicare reforms similar to those outlined by the AMA, in a bill sponsored by Rep. Charlie Rose (D-N.C.).

The AMA’s plan would create state-level “risk pools” to provide group insurance policies for the medically uninsurable, small businesses and others unable to afford coverage. About 15 states already have such trusts; California is not among them.

The AMA also would revise medical malpractice laws to reduce liability insurance costs for physicians. The group is pushing for the Federal Trade Commission to relax antitrust restrictions against the establishment of a peer review process. Such a structure would try to settle patients’ claims without relying on expensive litigation before a jury.

AMA officials rejected the suggestion that the United States should consider adopting a national health scheme patterned after Canada’s, in which the government pays all of its citizens’ medical bills and sets charges for physicians.