AMA Officials Urge Insurance Coverage for All

In an unprecedented move, leaders of the conservative American Medical Assn. Monday urged the federal government to guarantee basic medical insurance to all Americans, saying it is “no longer acceptable morally, ethically or economically” for some 33 million citizens to live with inadequate or nonexistent health insurance.

The AMA officials, using uncharacteristically strong language, also blamed “long-standing, systematic, institutionalized” racism--including that of organized medicine--for the fact that most of the uninsured and under-insured are members of minority groups.

Monday’s bold challenge to President Bush and Congress to curb runaway health-care costs while providing basic universal coverage coincided with the AMA’s publication of more than 70 health-care reform proposals being advocated by a wide range of interest groups, from labor to advocates for the poor.

The proposals cover the entire gamut, ranging from tinkering with the Medicare and Medicaid programs to adopting the Canadian system of universal health care. Among them were the 1990 Pepper Commission report, which would require all employers to provide health insurance to their workers. They also included the AMA’s own reform plan, which would call on a combination of government and business to provide every American with “affordable coverage” while preserving a patient’s right to select his or her own doctor.

AMA officials on Monday did not promote their own proposal per se; rather, they urged a vigorous national debate on the merits of all the contending ideas--and challenged Bush to produce his own proposal.

“I don’t know what the solution is. But I believe that somewhere in these pages we have many solutions that would work and be an improvement over what we now have,” said Dr. George D. Lundberg, editor-in-chief of the Journal of the AMA (JAMA) and a major force in the growing national debate.

The AMA’s push for health-care reforms stands in sharp contrast to its role during the Lyndon B. Johnson Administration, when the physicians’ organization fought vigorously against congressional enactment of Medicare and Medicaid.

The Bush Administration on Wednesday will unveil its initial response to the burgeoning health-care crisis, sending Congress a plan to induce state reform of medical malpractice insurance, Vice President Dan Quayle disclosed while on a trip to health clinics in Chicago Monday with Health and Human Services Secretary Louis W. Sullivan.

The plan is aimed at reducing the use of unnecessary medical practices to forestall lawsuits and preventing doctors from refusing to perform high-risk procedures, Administration officials said.

Many reformers criticized the narrow scope of the White House proposal. The AMA is “very pleased” with the President’s tort reform plan, said Dr. C. John Tupper, AMA president, “but the real issue is the cost of defensive medicine”--not malpractice awards.

“There’s a burning need for (broader) reform,” added Tupper, a Davis, Calif., internist.

Alluding to the assortment of programs adopted recently by many states to encourage private insurers to provide low-cost health insurance, Tupper added: “There’s a very real ferment out there in the state legislatures. And we need to bring this issue to the halls of Congress and to the White House.”

Also on Monday, the Bush Administration announced a new, $171-million program to extend prenatal care to pregnant women in their first trimesters as a way to reduce the nation’s high rate of infant mortality.

Most Americans have basic health insurance. But as the cost of medical care continues to soar--now accounting for 12% of the Gross National Product and still climbing--more and more people are being squeezed financially or are being abandoned altogether by insurers. At the same time, employers are experiencing alarming increases in their health-care costs provided to employees.

In leading Monday’s unprecedented call for federal action on the health-care crisis, Lundberg arranged for JAMA, as well as the AMA’s nine specialty journals, to simultaneously publish single-issue editions devoted entirely to the health-care crisis.

“We as a developed country, along with South Africa, are the only two such countries that have no national health policy and have no plan nationally to take care of all of our people at a basic level,” Lundberg said at a press conference here. “I would hope that there would be leadership in the executive branch, which will recognize this as a moral imperative as well as a pragmatic necessity to get on and solve the problem.”

He added: “I’d like to see the Administration have its own comprehensive proposal so that it could also be on the table for the Congress and the people to chew on.”

Sen. John D. (Jay) Rockefeller IV (D-W.Va.), who chaired the bipartisan Pepper Commission, said Congress may enact some reforms during the current session, although many others were far less optimistic.

But on one point there was unanimity. As Dr. Rashi Fein, a Harvard University professor of health economics, put it: “This is a problem which is solvable and must be solved because it is going to get worse.”