MDs Break Ranks

MOST doctors in the US - like other professionals - oppose government regulation of their practices, including their fees. Physicians generally believe that government should let the market set fees and allocate medical resources.

Economists, policy analysts, and politicians who study ways to control soaring health-care costs have recognized that the medical establishment would resist proposals to limit fees and, as a result, that such proposals would meet stiff opposition in Congress.

Thus many observers were surprised this week when the American College of Physicians, the nation's largest medical-specialty group with 77,000 members, came out in favor of reform legislation that would establish a national budget for health-care expenditures and restrict the charges of doctors and hospitals.

This was part of a comprehensive reform package that also embraced a "play or pay" system whereby employers would be required to provide health insurance for their workers or make payroll-tax payments into a public fund for uninsured Americans.

The College of Physicians' proposal includes many of the reform elements broadly endorsed by Democratic presidential candidate Bill Clinton. President Bush opposes both "play or pay" and fee caps, preferring tax breaks and streamlined competition to improve the health-care system.

Some commentators hailed the College of Physicians' acceptance of fee limits as a breakthrough in the debate over health-care reform, but that's far from certain. The organization is variously characterized as a "pioneering" or a "maverick" group; whichever, its thinking hardly reflects that of the medical establishment, including the heavyweight American Medical Association.

It's too early to say that the proposal is a harbinger of consensus on health-care reform, but at least it's an intriguing new ingredient in the policy stew.