AMA to Be Neutral on Health Plan : Medicine: Largest, most influential group of physicians gives notice it will lobby for key changes. Position is modest victory for White House.

WASHINGTON —  In what amounts to a modest victory for the Administration, the American Medical Assn., which has historically opposed government intervention in medicine, announced Wednesday that it will “neither endorse nor oppose” President Clinton’s health care reform plan.

At the same time, however, the nation’s largest and most influential group of physicians put the Administration on notice that it will actively lobby Congress for a number of significant changes in the program, including tougher limits on malpractice claims.

The AMA’s stance is extremely important to the President because the group’s 300,000 physician members are certain to influence the views of their patients as well as many members of Congress. By persuading the AMA not to oppose the plan, the Administration has guaranteed that the President’s bill will not be rejected outright before it is voted on by Congress.

So far, of all the major lobbying groups with a stake in the health care reform debate, only the National Federation of Independent Business, which represents small employers, and the Health Insurance Assn. of America, which represents the smaller insurance companies, have announced strong opposition to the President’s plan.

AMA officials indicated that they have chosen not to join the opponents because they hope that by being supportive they can play “a broker role” in drafting the details of the final legislation, which could emerge from Congress within a year.

Lonnie R. Bristow, chairman of the AMA board of trustees, announced the AMA’s position at a meeting of the group’s lobbying arm. He said that the organization had decided to “neither endorse nor oppose the (President’s) plan in its entirety.”

In part, the AMA’s position reflects a concerted effort on the part of the Administration to be conciliatory toward major special interest groups. Not only were many AMA ideas incorporated into the bill, but Health and Human Services Secretary Donna Shalala assured the group in a speech Wednesday that most details are still negotiable.

Shalala said that the Administration does not assume “that we know all the answers.”

Since the 1940s, the AMA has been almost single-handedly responsible for defeating a long series of political proposals designed to revamp the health care system by characterizing most of them as a first step toward socialized medicine. But beginning in 1990, the AMA itself began speaking out for specific reforms, some of which ended up in Clinton’s proposal.

While the doctors applaud the President’s call for every employer to provide their employees with health insurance, the AMA has said that it believes Clinton’s plan is underfinanced, especially in funding for medical education. They also want tougher restrictions on malpractice awards and antitrust exemptions for doctors to form managed care networks.

“The President has offered the country a prescription for what ails our health care system,” Bristow said. “And while we agree with his general diagnosis, we disagree with some of his treatment decisions. He is prescribing some pretty stiff new medicine. And we’re worried that no one really knows what the side effects are going to be.”

In fact, AMA members booed Shalala when she outlined the Administration’s proposals for changing the medical liability system, which would provide for arbitration and would bar plaintiffs’ lawyers from receiving fees in excess of one-third of an award. The AMA wants Clinton to impose a limit on malpractice damage awards.

In addition, Bristow explained in an interview, the AMA also strongly opposes the President’s proposals to limit increases in medical spending to no more than the overall rise in the Consumer Price Index by the year 1999. He also said his organization believes that Clinton’s plan would create too much bureaucracy.

To explain its position, the AMA group has mailed a 15-page letter to all of the nation’s 600,000 physicians--including those who are not AMA members. The letter includes two pages of AMA answers to questions commonly asked by patients about health care reform.

Reflecting the high degree of interest doctors have in this proposal, more than 600 physicians showed up for the AMA’s so-called “political education conference,” which usually attracts no more than about 250 members. All of them were sent to Capitol Hill on Wednesday with instructions to “make house calls” at the offices of their representatives.

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