Doctors’ Group Backs Health Spending Cap : Medicine: American College of Physicians call for fee limits. Plan mirrors proposal by candidate Clinton.

WASHINGTON — The American College of Physicians broke ranks with most other doctors’ organizations Monday and called for a national cap on health care spending, enforced by “limits on doctor and hospital fees.”

“We announce our support for a national health care budget and reasonable limits on fees,” to be set in negotiations with doctor and hospital groups, said Willis C. Maddrey, president of the group, whose membership of 77,000 doctors of internal medicine makes it the nation’s largest society of medical specialists.

The proposal comes in the middle of a presidential election campaign in which rising health care costs are a topic of debate.

The ACP is the second major doctors’ group to support some sort of limit on physicians’ fees. The 74,000-member American Academy of Family Physicians took a similar stance several months ago. All others--including the American Medical Assn., the largest--strongly oppose direct government cost controls, as does President Bush. The physicians’ proposal resembles that of Democratic nominee Bill Clinton.

The President favors marketplace competition among large medical groups to determine which can provide insurance and care at the lowest cost, changes in private insurance rules to cut costs and guarantee that everyone can buy insurance, and revision of medical malpractice liability laws to hold down costs.

Clinton’s proposal for containing health costs has a similar national cost cap (or “global budget”) as its central feature. But ACP officials said they have been working on their plan for five years and did not announce it as a way of taking a position in the presidential campaign.

Nonetheless, a Clinton aide Monday called it “absolutely a breakthrough” and said it is “a clear example of physicians showing leadership and moving to the forefront of the reform effort.”

Maddrey said his group, which had “long resisted government involvement” in direct spending controls and fee setting, recognizes “times have changed” because health costs are mounting so fast.

But Ray Scalettar, chairman of the AMA’s board of trustees, called the idea a “naive approach.”

“What it fails to recognize is that physicians and patients are interested in health care. The government is interested in cost.” Scalettar said it would lead to “rationing of care, a ratcheting down on procedures and initiatives.”

Gail Wilensky, a Bush health aide, said the Administration opposes the ACP approach. She said it favors realigning the incentives within the medical system to hold down costs and “provide the financial wherewithal for people who are too low-income to find their own health care.” But she said it does not favor having the government make all decisions and impose caps.

Besides negotiated cost caps, the ACP plan mandates that all employers either “offer their own health coverage” to their workers or “pay a tax to enroll their workers in publicly sponsored insurance.” The amount of the tax would be decided later.

Terry Hill of the National Federation of Independent Business, which represents mostly small firms, said: “We will not support anything that has an employer mandate in it.” He said his group is skeptical that cost caps would save much money. “The numbers we’ve seen on anything like that never come close to reality.”