Health Reform Plan to Allow Choice of Doctor : Benefits: Key Clinton adviser says preventive care also will be a major part of the insurance package.

President Clinton’s health reform plan will allow Americans the freedom to “follow their own doctors” into new provider networks, and its basic benefits package will include preventive services rarely covered by current insurance programs, the Administration’s chief health care adviser said Friday.

“There should be a choice of physicians--you shouldn’t herd people into one plan or another,” Ira Magaziner, who is directing the Administration’s 500-member health care task force, told a gathering of consumer groups.

Addressing an issue that many advisers consider critical to the success of the reform effort, he emphasized the President’s desire to allow people to “be able to choose their own doctor.”

The Administration appears eager to assure consumers who now have relatively good health insurance coverage that they can continue their current relationships with their family doctors or specialists.

In an extensive two-hour question-and-answer session, Magaziner provided other significant new details on the health reform package that the Administration will unveil next month. Among them:

--The government would create special incentives to get doctors and nurses to work in poor city neighborhoods and in rural areas, to “make it attractive to go there and stay there.”

--Antitrust laws would be eased to allow local groups of doctors and hospitals to join together in the creation of health care networks.

--The popular Medicare program would be largely untouched by the reform package, other than the addition of some new benefits that will be part of the universal package. The Administration is very “conscious of not wanting to break something most elderly people feel is working pretty well,” Magaziner said.

The Administration’s package will have a basic set of health benefits guaranteed for all Americans. The coverage will be universal and portable, following each American, regardless of health status or employment, Magaziner said.

Care will be delivered under a “managed competition system,” with residents of a geographic area choosing among several health plans meeting government standards. Local purchasing cooperatives would certify a variety of acceptable health networks.

An urban area such as Los Angeles might have six or eight different choices available.

The plans might include a health maintenance organization, with a restricted list of doctors and hospitals, a preferred provider organization with a somewhat broader list of doctors, or a traditional fee-for-service plan allowing the patient to choose any physician. The fee-for-service plan would be more expensive for those choosing to join it.

All Americans “should be able to follow (their) own doctor” into the kind of plan the physician chooses to join, Magaziner said. “Americans don’t want to be told they can’t stay with their own doctors,” he told the meeting, which was organized by Families USA, an advocacy group active in the health reform campaign.

The audience included representatives of more than 200 organizations, including women’s groups, labor organizations and health groups.

All of the plans would have to offer at least the basic benefits package, providing hospital and doctor services--including mental health care--and some prescription drug coverage.

The plan will “add some serious preventive pieces” to the kind of comprehensive health care coverage now available at the “top end” of insurance coverage, according to Magaziner. “There are a whole set of preventive measures not (routinely offered), and we will recommend they be included,” he said without providing details.

Many insurance programs do not provide coverage for such procedures as annual physical examinations, checkups for healthy children and mammograms to detect breast cancer.

The package is likely to require substantial new taxes because it will be offered to 37 million Americans who now lack health insurance entirely and because it will be far more comprehensive than the existing coverage for millions more. President Clinton has not yet decided on financing methods, Magaziner said.

Most Americans with health insurance receive the coverage through their employers, and the Administration has not decided on the precise role that those employers should play, other than to require that all companies cover all their employees. Businesses would pay the bulk of the cost, with subsidies for small companies and low-wage firms.

Companies could run their own health insurance programs, provided that they meet the basic national benefits package, according to Magaziner. Workers could choose their company’s plan. Or they could select one of the competing health plans offered by the local purchasing organizations and their company would pay the bulk of the costs.