Town Hall Health Hearing Presents Few Cures : Medicine: Mrs. Clinton appears daunted after listening to litany of complaints about the nation's system--but she hears no solutions.

By DAVID LAUTER

March 13, 1993 12 AM PT

TIMES STAFF WRITER

TAMPA, Fla. — Hillary Rodham Clinton brought the town hall meeting--a favored element of her husband’s presidential campaign--to the drive for health care reform Friday, hearing a sobering series of complaints about the medical system that seemed to leave her daunted.

“I don’t know that it is possible to satisfy every need that was heard today,” Mrs. Clinton said after listening to some five hours of testimony. “We will have to make some very hard decisions.”

Like a campaign event, the first of four hearings sponsored by the Robert Wood Johnson Foundation, a private organization that devotes much effort to health issues, was carefully controlled to bolster the Clinton Administration’s fundamental premise in health care policy. White House and foundation officials planned the hearings in recent weeks as complaints mounted that most of the Administration’s health care planning was taking place behind closed doors.

Although dubbed a “Dialogue with the American People,” the discussion included few who expressed even mild doubts about the premise that the nation’s health problems require a large and new role for the federal government.

Nonetheless, the procession of horror stories--accounts of inefficient, incomprehensible or immoral aspects of the current medical system--served to highlight the complexity of the Administration’s task.

A lawyer told of a 31-year-old quadriplegic client who is about to be moved from $27,000-per-month home care to $95,000-per-month nursing home care because Medicare will pay only for the latter.

A small-business owner told of being unable to find insurance except for a plan that required a $10,000 deductible.

A doctor spoke of a poor patient for whom Medicare would not buy $100 in medication. As a result, the patient incurred a $30,000 emergency room bill--that Medicare did pay.

But as in most discussions of health care, the day’s events provided far more evidence for the problems than support for any proposed solution. And virtually no one talked of the potential costs of what the Administration is likely to propose.

About the only exception was Dr. Peter Levin, dean of health policy at the University of South Florida. “I want all of the people with chronic illness to be covered,” he said after listening to witnesses talk of the astronomical medical bills they face. But reform of medicine will not be free, he warned.

“I also know that freedom of choice” and other aspects of traditional medical practice “are going to have to come to an end,” Levin said.

Elsewhere Friday, the drug industry proposed a plan to voluntarily hold overall price increases to the rate of inflation as a way of containing health care costs.

The Pharmaceutical Manufacturers Assn., which represents the nation’s major drug firms, said it would put such a plan into effect if the Justice Department grants the industry an exemption from federal antitrust laws to allow officials from various drug companies to discuss voluntary price restraints.

Under the proposal, companies could increase the price of individual drug prices by a rate higher than the Consumer Price Index, but would compensate by lowering price increases on other drugs so the average of all of the increases would remain at or below the level of inflation, the association said.

The price restraints would not apply to the price of new drugs, only to price increases after they are on the market, it said.

At the health care hearing, Mrs. Clinton provided few, if any, clues about where the Administration may be headed on health reform. Instead, as she has in previous public appearances, she stuck to general statements about the importance of preventive health care and expanding the role of primary-care physicians.

Health and Human Services Secretary Donna Shalala and Tipper Gore, wife of the vice president, said even less, sitting nearly silent through the testimony.

“It would be premature to focus on solutions today,” said Dr. Steven A. Schroeder, president of the foundation. “It would be a disservice to our country to think there is a single magic bullet.”

Few panelists or members of the audience, however, lacked at least one round to fire.

Nurses advocated a greater role for their profession in delivering care--arguing that in many cases they can provide the same care as doctors but with lower cost. Families of disabled people and advocates for the elderly talked of the need for long-term care insurance.

Administrators of rural clinics urged more aide for their facilities. Independent druggists warned that they were being squeezed out of business by large chains cutting special deals with preferred payer networks.

Owners of small businesses warned that a government requirement that they insure their workers would lead to ruinous layoffs.

And several speakers drew applause when they criticized the basic solution that the Administration appears to be inclined toward to hold down spiraling costs--the mixture of private insurance and public regulation known as “managed competition.” In theory, managed competition would enable consumers to pool their buying power and shop among health care providers for the best services and prices.

David E. Bussone, president of Tampa’s primary teaching hospital, for example, called managed competition “an oxymoron” and called for a temporary wage and price freeze on all aspects of the medical system until a complete system of “very, very heavy regulation” can be put in place.

Perhaps the best summary of the day came from the president of the Orlando Regional Healthcare System, J. Gary Strack, who presented Mrs. Clinton with a model of a frog and an accompanying aphorism he attributed to his stepfather.

“If you’ve got to swallow a frog, don’t spend a lot of time looking at it,” he said. “If you’ve got to swallow several frogs, don’t swallow the smallest one first.”

“My husband has collected frogs for a long, long time,” Mrs. Clinton responded. “I’ll take it back with the advice that he’s going to have to swallow some big ones.”

Times staff writer Marlene Cimons contributed to this story from Washington