HEALTH REFORM PLAN WILL ENSURE APPROPRIATE TECHNOLOGY UTILIZATION, HHS' LEE TELLS HIMA; SHALALA SEES "MINOR OVERSIGHT" ROLE FOR NATIONAL HEALTH BOARD

President Clinton's health care reform plan will ensure appropriate levels of technology utilization by simultaneously reversing the "underuse of effective and appropriate technology" and reducing the overutilization that results from "defensive medicine," HHS Assistant Secretary Philip Lee maintained Oct. 5 at the Health Industry Manufacturers Association's payment conference in Arlington, Virginia. The changes would result in "significant improvements in quality of care," Lee asserted. Under the White House proposal, Lee added, Americans would "certainly be seeing increased use of technology" in the areas of preventive and long-term care. According to an initial draft outline, the Clinton health reform plan includes provisions for expanded preventive and long-term care benefits ("The Gray Sheet" Sept. 20, p. 15). Addressing the role of a National Health Board under the White House plan, Lee explained the body would play a "major policy role" in deter- mining "what technologies would be covered as a medically necessary benefit." Lee added that he did not agree with those who have proposed limiting the board's authority over the benefits package by recommending congressional oversight in this area. The Clinton proposal would give the National Health Board power to "interpret and update" the guaranteed benefits package, and also to enforce the national health budget and implement a quality management program. HHS Secretary Donna Shalala continued the administration's effort to downplay the power of the National Health Board at an Oct. 5 joint hearing of the House Energy and Commerce/Health and Consumer Protection Subcommittees. She termed the board "a relatively minor oversight group" with 11 as little as 100 people" on staff. "I do not think we're talking about a huge bureaucracy with the National Health Board," she added. The White House proposal would allow the board to hire "sufficient staff" to carry out its duties. House Majority Leader Richard Gephardt expressed willingness to scale back the power of the National Health Board at an American Medical Association conference Sept. 30 in Washington, D.C. Responding to physician concerns with the board, Gephardt stated: "If the board is a problem, then let's take a look at it, let's tear it apart [or] not do it...None of us is interested in adding bureaucracy or adding complication. Quite to the contrary, we want whatever is put in place to move in the opposite direction." Julie James, minority staffer to the Senate Finance Committee, noted at the HIMA meeting that Senate committee chairmen are already battling over jurisdiction of the yet-to-be introduced Clinton health reform bill. She added that the Labor and Finance Committees disagree on the timing of reform; Labor and Human Resources Committee Chairman Edward Kennedy (D-Mass.) has scheduled a busy hearing schedule for the fall and plans to mark up the bill by Christmas, while Finance Committee Chairman Daniel Moynihan (D-N.Y.) has scheduled "very general" hearings and will not tackle the details until very well into next year." Also addressing the HIMA meeting, Federation of American Health Systems Executive Director Michael Bromberg predicted that the health care reform legislation ultimately enacted by Congress will look a lot like Rep. Jim Cooper (D-Tenn.) and Sen. John Breaux" (D-La.) "pure managed competition" plan; the bill was introduced on Oct. 6.