Californian doctors' managed-care plan

Californian doctors' managed-care plan

Clinton unveils modest new go bankrupt in 2002-by an additional three years. Democrats on Capitol Hill were furious costs themselves, which often ma...

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Clinton unveils modest


go bankrupt in 2002-by an additional three years. Democrats on Capitol Hill were furious costs themselves, which often makes the with this aspect of the plan, noting that : recent attacks on Republican efforts to proposition unaffordable. A second set of proposals are the curb the growth of the massive health pro"consensus" items common to both the grammes had been boosting Democrats’ original Clinton health plan and own popularity. "Opening the door to Republican bills. These include banning deep Medicare cuts while the Republicans insurance companies from denying are struggling to pay for their huge tax coverage (or raising premiums once a breaks threatens to make Medicare a person is covered) based on pre-existing political football", complained House medical conditions; creating purchasing Minority Leader Richard Gephardt pools to help individuals and small (Democrat, Missouri). businesses obtain more favourable insur: While health-care providers are already ance rates; and increasing the healthcrying foul over being asked to shoulder insurance tax-deduction for self-employed the entire burden of the cuts, the adminispeople (currently 30%: the new proposal tration is hoping to buy-off Medicare would raise it to 50%). : beneficiaries (and the powerful groups By far the most controversial aspect of that represent them in Washington), not the plan is the administration’s offer to only by promising not to raise their costs, reduce Medicare spending by US$124 : but also by offering them more than$13 billion over the next seven years and to billion worth of new benefits. Among cut Medicaid by$54 billion over the same these are a new programme to provide period (about 40% of the amount prohome and community-based long-term posed by Republicans in care; a "respite" benefit for families who Administration officials emphasised that care for patients with Alzheimer’s disease; the cuts would affect only doctors, hospiand a waiver on the co-pay requirements tals, and other health-care providers, for women receiving mammograms, while not harming recipients of the prowhich essentially makes them free. grammes. They also noted that the cuts would extend the solvency of Medicare’s hospital trust fund-currently scheduled Julie Rovner

US health-reform bill

to .

Nine months after his massive health overhaul went down to ignominious defeat in Congress, President Clinton last week unveiled a new, much more modest health-reform bill-including some controversial cuts in Medicare and Medicaid, the two main federal health programmes. Even before Republicans captured the Congress last autumn, the President and his advisers had acknowledged that they had tried to do too much at once, and would instead propose reforms of the "incremental" variety. But debate had raged within the White House over which reforms could be implemented without making the health system’s two main problems-rising prices and a growing percentage of Americans lacking health insurance-worse. The new proposal, which the administration may or may not write into a formal legislative proposal, focuses on making it easier for those who currently have health insurance to keep it. A key feature is a six-month subsidy to help people who lose their jobs to keep their health coverage. Currently, those who leave a job are entitled to continue to buy insurance from their former employers for 18 months, but they must pay the full






Californian doctors’

managed-care plan their loss of control over medical decision making in the fiercely com-

Piqued by

petitive capitation climate, California physicians are on the verge of founding their own statewide, physician-owned managed-care plan offering both health and preferred provider organisation type plans. Called California Advantage (CA), the plan is open to all 74 000 of the state’s physicians willing to invest$1000 by July 14 for the purchase


share of stock and to pay a fee if California Medical Association members. The CMA developed the CA plan and made a loan of$500 000 but has no liability or responsibility for the : organisation, according to officials. CA is scheduled to be marketed in 1996 provided at least 3000 physicians sign up. In mid-June, CA officials said that 2000 physicians had qualified and "at least another 1000" had made verbal commitments. 500 of the signatories must be primary-care physicians. Announced in March, the plan has attracted "tremendous" response from employer groups and from labour and county employee coalitions, according to Dr Sidney Foster of San Francisco, CA’s vice-chairman. Plans call also for the future formation of a managed-care Workers’ Compensation Plan. Physicians and medical societies in about 12 other states, including New York of



are not


and Washington, are in varying stages of : forming similar plans, Foster said. Although it is a for-profit corporation, organisers say CA shares are not expected to make a profit. By setting a cap of 15% for administration costs and profit, they say they will be able to devote the maximum percentage of the premium dollar to providing health-care services. Physicians have been highly critical of many of the 35 existing HMOs in the state for paying top

Reform proposal for Food and Drug Administration

Members of Congress are still skirmishing over the US Food and Drug Administration, which they have targeted for an overhaul in the wake of persistent criticism by the pharmaceutical, biotechnology, and medical-device industries that the agency is too slow and cumbersome. The latest volley was fired on June 6 by officials excessive salaries while skimping on services and running roughshod over Representative Ron Wyden, a Democrat physicians and narrowing their control of from Oregon, who submitted legislation patient care. An example is the practice of that would privatise aspects of the some large HMOs to require physicians to agency’s functions, improve regulation of sign "gag" orders, which prevent them biotechnology products, and create an from criticising the plans. : even faster track for approval by allowing More than half of all Californians products for life-threatening disease to be already receive health care through marketed "conditionally" while the agency managed-care plans. This circumstance weighs evidence from ongoing trials for provides sceptics with reason for predicting final approval. The bill also proposes to tough times ahead for CA. They cite the soften FDA’s stance on dissemination of heavy start-up costs, difficulties in obtaining information on unapproved uses of pharenough primary-care physicians, and the maceuticals, by allowing drug makers to already heavy saturation of managed-care distribute peer-reviewed journal articles plans in some urban areas. : and other "scientifically valid" informa"In a business sense, I think it possibly tion, if such distribution has been cleared will succeed, but it’s not going to change first by the agency. the rules of the market and it won’t Wyden, known for being pro-consumer change anything for patients", said one and pro-FDA, is a surprising attacker. But with many Republicans calling for a critic, Dr John Ruark, a Berkeley gastroenterologist who is chairman of the dismantling of the agency, a Wyden California Physicians for National Health spokesman says that the congressman Reform. : "believes very deeply that unless proconsumer types like himself begin assertNelson Harry ing themselves, then we’ll lose some of the