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White House Rejects AMA Request to Be Part of Task Force

By Marilyn Milloy


The White House Thursday rejected a request by the American Medical Association for a greater role in the nuts-and-bolts shaping of a plan to overhaul the nation's health care system, saying the group's voice already was "significant" and that as a policy, no interest group was being afforded the level of participation it was asking.

The request, made in a letter this week to Ira Magaziner, a White House senior policy adviser who is coordinating the president's task force on health care reform, came after weeks of public complaining by association leaders about being left out of the process. In the letter, AMA President James S. Todd warned that any reform "will fail without the support of the profession." But he was careful in an interview Thursday not to appear to issue an ultimatum.

In fact, leaders of the influential association have met with Magaziner recently and with other Clinton officials during the campaign and through the transition, said White House press secretary Dee Dee Myers. And "town meetings" are being planned in which their participation has been sought.

But because of a White House conflict-of-interest policy, AMA members, like those affiliated with other interest groups, have been barred from attending meetings of the task force's 30 "working groups." So have the media and the public.

But Todd said Thursday that it is in those working groups where the real work is being done, where the haggling over options is taking place and where the group's "expertise" would be most effective. "Why won't they let us use that expertise?" he asked. Todd said he had not received a formal answer.

Administration officials say there are doctors on the task force, but the perception -- fed by its secret nature -- is that these physicians are not "people who are down in the trenches, practicing medicine," as Dr. Arthur Berken of Bethpage, N.Y., put it. Berken, who has written a book promoting a German-style health care system supported by payroll taxes, added, "It's people like me who understand what medicine is like in the community, not medical economists."

Still, Todd insisted that the group would maintain what has been an increasingly conciliatory tone about the need for reform generally, and specifically about its support for universal coverage and some elements of "managed competition" -- the theoretical, market-based model of health care reform embraced by the president.

In past years, the AMA has been among the most recalcitrant groups on the issue of reform of health care financing. But no more. In the letter, for instance, Todd reiterated the parts of the Clinton plan they embrace, and noted that the association would support some sort of national "spending goals" -- but, significantly, not spending limits, as Clinton has suggested, that could result in regulating or capping doctor's fees. "Any kind of price controls we're against," he said.

Still, said Todd, "We do not want to be confrontational. It's not tit for tat. We're just saying, `Here are several propositions, now let's deal with them -- together."