Today’s Topic

While President Clinton and Congress wrangle this week over a final health-care reform bill, there is a sense in the medical community that no matter what the agreement the delivery of medical care in the United States will be vastly different in the coming years.

Topping the list of challenges for the Clinton Administration is cutting the astronomical cost of health care, which could reach a total of $1 trillion for 1994 alone, according to the People’s Medical Society, a consumer group based in Allentown, Pa.

In today’s Platform, a panel of health-care professionals discusses one of the cost-cutting changes already taking place: the growing numbers of licensed caretakers who are performing simple medical procedures in place of doctors.

Although in most cases these health-care providers are by law required to work in tandem with a medical doctor, the trend still stirs controversy.

These professionals--nurse practitioners, physician assistants, nurse midwives, nurse anesthetists, dental hygienists and opticians--argue that they have enough education and meet enough licensing requirements to safely minister to patients without the supervision of a doctor.

Physicians, on the other hand, worry that these health-care providers are not trained to deal with potential life-and-death problems.

“We’re not opposed to change,” says Steven Thompson, vice president for government affairs for the California Medical Assn., a physicians’ lobbying group. “We’re opposed to change that jeopardizes the patient.

“We have not opposed legislation that allows some expansion of scope of their responsibilities,” Thompson says. “But if there is something beyond their scope, we want to make sure a physician is present to make sure the appropriate medical supervision is available.”

Not surprisingly, that view does not sit well with other health-care providers. They charge that physicians are not so much concerned about patient care as they are about their own pocketbooks.

“The real problem is that nurse practitioners and physician assistants want to get paid for doing the procedures,” says Donna Ver Steeg, who heads the primary care unit of UCLA’s School of Nursing. “They perform the procedures but the doctor sends in the bill to the insurance companies.

“Their rates don’t approach those of physicians,” Ver Steeg says. “They are not doing things that are dangerous. The average primary-care problems are not of the magnitude one would expect a physician to be treating.”

That view is generally supported by consumer groups. “We feel there should be more choice for the medical consumer,” says Mike Donio of the People’s Medical Society.

“As a consumer, shouldn’t I have the choice to go, for example, to a dental hygienist who would clean my teeth for $20 or $25 instead of a dentist who would charge me $60 for the same procedure?” Donio asks. “We want to control the rate that medical costs are increasing,” Donio adds. “We want to be able to purchase those primary care services at a lower cost.”