In a speech seemingly tailor-made for her audience _ the nation's doctors _ Hillary Rodham Clinton outlined the administration's broad goals for health care reform Sunday, asking for a "new bargain" with physicians.
Repeatedly interrupted by applause, Mrs. Clinton appeared to salve any lingering resentments between the administration and the branch of organized medicine represented by the American Medical Association.
She praised the profession, while delivering scathing attacks against the unnecessary burdens placed in the way of treatment by government and private insurance bureaucracies.
"This system is not working," Mrs. Clinton told the group's annual House of Delegates meeting, which brings together representatives of 90 percent of the profession.
"What we need is a new bargain. We need to remove from the vast majority of physicians these unnecessary, repetitive . . . forms and instead substitute for what they were attempting to do: More discipline, more peer review, more careful scrutiny of your colleagues."
James Todd, the AMA's executive vice president, said Mrs. Clinton's appearance before the House of Delegates was "testimony to her understanding of the critical role physicians will play in health care reform."
Many elements within organized medicine, especially physicians, have expressed concern that their voices were being ignored in the administration's reform debate. Recent meetings between doctors and task force members, including one Sunday with Mrs. Clinton, have eased that enmity.
Todd said the most difficult questions of how to finance reform and universal access to health care will not be answered by the administration until details of its plan are revealed, which may not be until the fall or later.
"We are encouraged that many of the elements we have proposed are being considered by President Clinton," Todd said.
Mrs. Clinton sided with several of the AMA's positions, including preserving the right of patients to choose their own physician; lessening of paperwork and oversight by insurers; insurance coverage of the cost of prescription drugs; and reform of the malpractice system.
"I'm not suggesting you would agree with all elements of the proposal," Mrs. Clinton said. "If everybody's not a little put out, then we haven't done our job."
In her 50-minute speech, Mrs. Clinton described the tragic case of a New Orleans woman who, employed but without insurance, was sent to a specialist when a lump was found in her breast.
"He said because of that (lack of insurance) he would not do a biopsy or even keep an eye on it," she said.
Mrs. Clinton said universal health insurance coverage for all Americans was the first priority.
She listed other aspects likely to be part of the reform package, such as a community rating system to broaden risk, elimination of restrictions on patients with pre-existing conditions, a guaranteed package of primary and preventive care, a system of monitoring patient outcomes, support for medical research that not only alleviates suffering but saves money and unspecified steps to contain soaring medical costs.
Emphasizing the need for preventive care and the training of more people in the field to practice general medicine, Mrs. Clinton said, "We need to be a system that does not (just) take care of the sick but instead promotes health."
_ Information from AP was used in this report.