Doctors' Cure

FEW PEOPLE DISPUTE THAT A WAY MUST BE FOUND to provide medical coverage for the more than 35 million Americans who have no insurance, and fewer still that the U.S. desperately needs at the same time to control the runaway growth of health-care costs (1991 total: $700 billion). The American College of Physicians has waded into this widening crisis with a dramatic plan for accomplishing those inherently contradictory goals. The society of 78,000 doctors has concluded that the only way to fix the U.S. health-care system is to set a budget and stick to it. Most surprising, the organization concedes that doctors' fees should be regulated. Says Dr. John Ball, executive vice president of the group: "We doctors are willing to make the first move."

The plan is a "pay or play" system that would replace Medicare and Medicaid while ensuring universal coverage as well. Employers would either cover their workers or pay a fee to a taxpayer-supported government system. This government plan would also cover the unemployed, people older than 60 and % Americans with high-cost illnesses, under a so-called global budget, with total annual spending to be set by Congress. While the proposed system resembles the Canadian plan, it would not prevent people from choosing their own doctors.

The plan stirred immediate debate. The Clinton campaign, which has offered its own pay-or-play system, applauded the proposal. The Bush Administration, which opposes fee regulation, attacked it. By far the sharpest criticism, though, came from the 271,000-member American Medical Association, which says the program would inevitably lead to medical rationing. Said Dr. James Todd, executive vice president of the A.M.A.: "Pay-or-play and global budgets are contrary to the American way." Perhaps, but then, so is a system that currently forces millions of American workers and their children to go without medical coverage -- a form of rationing in itself.