Allies in protest
Three established programs were to be replaced by a unified national system of health policy planning. Particularly objectionable was a provision giving a federal official, the Secretary of Health, Education and Welfare (HEW), the authority to designate local private agencies that would oversee the size and location of hospitals and be responsible tor trying to hold down healthcare costs. Who is in a position to regulate the location and size of hospitals, and the distribution of medical personnel, is especially important now with a national health insurance system likely. Under the old arrangement, state and local elected officials were able to control the operation of the three separate prograrns, the Regional Medical program, Hill-Burton hospital construction grants, and the Comprehen Health Planning Program. So the octors found some ready allies. Cover•ors-Dan Walker of Illinois among them - lobbied for changes in the bill. alongside the mayors and county executive. They protested that the local governing boards would not be account able to any elected officials. Secretary of HEW. "The of HEW would have all the power," complained Eibby Saries, the federal liaison representative in Walker's Health Cabinet.
It was a classic illustration of how the politics of the Republican administration's New Federalism can be bent out of shape, resulting in strange alliances. In this instance, the subcommittee chairmen. Rep. Paul G. Rogers (D., West Palm Beach, Fla.) and Sen. Edward M. Kennedy (D., Mass.) were pleasantly surprised by the administration's enthusiastic endorsement of an enhanced federal role in health resource allocation. HEW felt that unneeded hospital additions were sometimes authorized for local political and economic rather than health reasons. Health care is essentially a private industry with heavy federal financing, and the interest of consumers can best be protected by "non-political" private agencies, it was argued.
Doctors feared that the law would be an opening step that could lead to regulation of where they practice and how much they charge their patients. At first, hospital associations resisted the bill because of a section allowing the planning agencies to reassess and recertify institutional health services periodically. This part was toned down eventually and the hospitals came around to supporting the legislation. They were confident, apparently, that their interests and those of hospital builders would be adequateIy represented on the private boards.
Delay through disarray
Unhappily, from his standpoint, the executive director of the Illinois State Medical Society, Roger While, played a key role in advancing the bill through the House. White thought the AMA's lobbyists were not doing enough to kill the bill So he wrote letters to medical society leaders in other stales outlining a strategy. "If we get lucky." White suggested, '"we may create enough disarray within the committee to delay the whole bill for this session." His message came to the attention of the committee chairman, Rep. Harley 0. Staggers (D., Keyser, W. Va.), who resented such a line of attack.
Shortly before Congress adjourned, the Health Policy Planning and Resources Development Act of 1974 sailed through both houses and was signed by the President. Many of the features that would have excluded the governors from the action were removed, made optional, or otherwise fuzzed up by the House-Senate conference committee, the last opportunity for revisions. Several of the remaining provisions are sufficiently ambiguous that they can probably be interpreted by HEW as HEW sees fit.
Contributions from IMPAC
The Illinois Medical Political Action Committee (IMPAC) is one of the most generous recorded sources of financial support for political campaigns in Illinois, most of them Republican campaigns. IMPAC disbursed $297,702 in 1973 and 1974. Of that amount, $60,643 was given to unenumerated state candidates, the rest to congressional candidates. Only two of the 15 Illinois Republicans in Congress voted for the health planning bill. The two — Reps. Paul Findley of Pittsfield ($7,000) and John Erienborn of Elmhurst ($2,000)— happened to be among those who received contributions from IMPAC. The biggest recipients were two successful House candidates, Henry J. Hvde of Park Ridge and Rep. Edward R.' Madigan of Lincoln, $10,000 each. IMPAC gave $5,000 to Chicago Democrat Dan Rostenkowski, who is chairman of the new House Ways and Means subcommittee on health.
April 1975 /Illinois Issues/127