Hillary Clinton Offers Doctors a ‘New Bargain’ : Health: For less hassle and more trust, she urges more policing and primary care in return. AMA applauds talk.

Offering doctors “a new bargain,” Hillary Rodham Clinton told the American Medical Assn. on Sunday that the Administration’s health care reform plan will bring physicians relief from paperwork and help them regain an eroded public trust.

The First Lady asked physicians in return to do a better job of policing themselves and to focus more on preventive and primary care, rather than on the more lucrative and prestigious medical specialties.

With the health care task force that she headed now disbanded and its recommendations forwarded to President Clinton--although not yet made public--Mrs. Clinton has begun the sales pitch. The proposal seeks to revamp health care by extending benefits to every American while still cutting costs. It will have to be enacted by Congress.

Last week, Mrs. Clinton began an effort to salve wounded feelings and assuage doctors’ fears in an address at Johns Hopkins University in Baltimore.

Sunday’s speech to the AMA House of Delegates was an appearance before a group that has pronounced itself offended more than once during the task force process--first by the absence of AMA representatives on the committee and more recently by Mrs. Clinton’s remarks about medical “profiteering,” although she did not specify doctors.

This time, the First Lady reserved her most scathing criticism for “second-guessing” on the part of insurance companies and federal bureaucrats.

The AMA is a major contributor to congressional campaigns and plans a significant lobbying effort, on Capitol Hill and among members’ patients, after the reform plan is released. Polling, town hall forums, advertising and waiting-room literature are planned. The group represents about 290,000 doctors, more than 40% of the nation’s physicians.

Mrs. Clinton’s 50-minute talk in a ballroom at the Chicago Hilton and Towers was interrupted by prolonged applause several times from about 870 AMA delegates and alternates who are shaping the organization’s policy this week. They had invited the White House to send a representative and found out Wednesday that it would be the First Lady.

The physicians and AMA staff generally seemed pleased that Mrs. Clinton recognized their importance in the reform process. “What was new is an attitude, an attitude of wanting to work with us,” said Steven Seekins, AMA vice president for corporate and consumer affairs--although he said “the comfort level was already becoming higher.” After complaining about being left out of the reform process, AMA leaders met more than a dozen times with task force members and working groups.

“She held out a hand in partnership,” said AMA board member Nancy W. Dickey, “looking to us for suggestions and our cooperation to make it work.”

Many at the meeting agreed with the goals that Mrs. Clinton highlighted: quality health care for all Americans, a benefits package that includes prescription drugs, and a commitment to medical research.

But they also said they need to see details of the plan before offering their support.

Many questions, particularly regarding malpractice reform and price controls, remained unanswered. “How are they going to be paying for this?” Rama Pemmaraju, a 30-year-old medical resident at Dallas Presbyterian Hospital, asked.

Mrs. Clinton’s address tied health reform to a need for renewed hope and optimism in a wide range of American institutions, from the family to police to the education system. The public, she said, has been left “with a sense that our problems have grown too large and unmanageable.”

While “not suggesting that you will agree with everything” in the reform package, Mrs. Clinton told the doctors that she believes they “will find in this plan much to be applauded and supported.”

And she addressed physicians’ discontent with the current status of the nation’s health care system. “I know that many of you feel that as doctors you are under siege. We are witnessing a disturbing assault on the doctor-patient relationship.”

Employers who buy managed-care insurance plans for their workers are limiting choice more than the Administration’s plan will, she said. Even when doctors want to affiliate with a plan for a longtime patient’s sake, she said, often “he, or she, I should say, is frozen out.”

Under the Clinton proposal, she said, “the employer does not make the choice as to what plan is available to the employee. The employee makes that choice.” Doctors, she said, will be able to join more than one health care plan.

The First Lady also attacked insurance companies and government bureaucracies, such as Medicaid and Medicare, for “second-guessing.”

“I can understand how many of you must feel,” Mrs. Clinton said, “when instead of being trusted for your expertise, you are expected to call an 800 number and get approval for basic medical procedures from a total stranger.”

The substitute for more freedom, she said, would be “more discipline, more peer review, more careful scrutiny of your colleagues.”

She also called on doctors to emphasize preventive care.