Published in the San Francisco Chronicle, March 27, 1997, page A3:

President Clinton returned yesterday to the issue that dominated the first year of his presidency, naming a commission to examine the quality and cost of health care.

The 32-member panel will explore the sweeping changes in health care, especially the trend toward managed care and health maintenance organizations. Clinton challenged the commission to develop a consumer's "bill of rights" to address the widespread fear that quality has somehow been compromised.

"In this time of transition, many Americans worry that lower costs mean lower quality and less attention to their rights," Clinton said in an East Room ceremony, with members of the new commission seated on either side of him. The panel will "help to chart our way through a time of profound change in health care. Their task will be focused and urgent - to find ways to ensure quality and to ensure that the rights of consumers in health care are protected."

More than 75 percent of working Americans with health insurance are covered through managed care, which replaces traditional fee-for-service care with a system in which the insurer frequently controls access to services. That shift is one of the reasons the commission created, White House aides said. The trend has also led to dozens of bills in Congress and in state legislatures that would set minimum benefits and limit some practices used by HMOs to control costs.

Last year, Congress enacted legislation requiring health plans to cover at least 48 hours of hospitalization after a mother gives birth. This year, Republican and Democratic lawmakers are pushing for a similar provision on mastectomies.

Although the commission's findings will not be legally binding, they could serve as the basis for federal and state legislation or as a set of voluntary standards for insurance plans. Clinton asked for a report by early next year.

Almost four years ago, Clinton opened a drive to radically reform the nation's health care system, proposing a complex plan to provide every American with health insurance "that can never be taken away." The effort was ultimately rejected by Congress, and it was widely blamed for Clinton's lack of popularity and the Democrats' defeat at the polls in 1994.

White House aides suggested that the changes likely to arise from the commission's work would be less comprehensive. Clinton said the "bill of rights" should contain simple measures to assure people that doctors can talk to patients about all medical options, that doctors are not rewarded for withholding care and that patients are able to appeal decisions denying coverage.

At least one Republican criticized the latest effort as a "politically inspired gimmick" that will lead to more spending and a bigger government.

"I doubt this commission will do anything than rubber-stamp the president's desired governmental intervention into health care," said California Representative Bill Thomas of Bakersfield.

Thomas was skeptical that the commission will operate in an independent and nonpartisan fashion because it will be led by Health and Human Services Secretary Donna Shalala and Labor Secretary-designate Alexis Herman.

Other commission members include representatives of business, consumers, labor, health care providers and insurers, along with policy experts.

Among the health experts serving on the panel is San Francisco Health Commissioner Sandra Hernandez. In announcing her appointment, the White House praised Hernandez for leading the city's homeless initiatives, "which are the model for cities across the nation."

For further information and feedback:
e-mail: frensasc@ix.netcom.com
John H. Frenster, M.D.
Physicians' Educational Series
247 Stockbridge Avenue
Atherton, CA 94027-5446
Phone: 415/367-6483
FAX: 415/364-1773

clinicalfreedom: "the ability of the patient and the physician to do all that is medically necessary without interference."