Like a patient preparing to take distasteful medicine, two House subcommittees began consideration yesterday of the Carter administration's proposal to bring soaring hospital costs under control.
After hearing from Health, Education and Welfare Secretary Joseph A. Califano Jr., health subcommittee members from the Ways and Means and Commerce committees expressed a variety of concerns about the administration's proposal to limit increases in hospital revenues and capital expenditures.
The warmest endorsement of the bill came from Rep. N. Giaimo (D-Conn.), chairman of the House Budget Committee, who avoided discussing any of the proposal's specific provisions but said that the "need is compelling and the time is right" to control hospital costs.
In his opening statement, Califano reeled off a series of stastistics calculated to show why the administration believes strong action is needed quickly. Hospital costs, rising at 2 1/2 times the rate of inflation, now account for 9 cents for every federal tax dollar, he said, mainly through Medicare for the elderly and Mediaid for the poor. Left unchecked, Califano told the committee, hospital costs will double within five years.
"There are many serious health problems in this country - affecting rural citizens, the working poor, the aged and children - which simply cannot be met without diverting substantial resources away from costly and unnecessary hospital care," Califano said.
He repeated his assertion that hospitals generally could be limited to an increase in 1978 of roughly 9 per cent in their revenues - higher if the overall inflation rate goes above 6 per cent - without affecting quality of care.
He cited a "fat list" of areas where cuts could be made without any adverse effect on health care. These included eliminating 100,000 empty hospital beds judged by local planning agencies and HEW to be surplus; removing from acure-care hospitals patients who could be better and more cheaply cared for at home, in a nursing home or on an out-patient basis; tightening controls on the purchase of expensive technology; eliminating expensive and unnecessary therapies, and reducing the number of tests performed on patients.
House Ways and Means Health Subcommittee Chairman Dan Rostenkow hearing that "we need to subject this ski (D-Ill.) said at the beginning of the specific proposal to critical and searching scrutiny - and to determine whether there are any more effective alternatives available to us for restraining rising costs and promoting efficiency in hospitals."
Rep. Otis G. Pike (D-N.Y.) told Califano that by limiting revenues rather than costs, the legislation proposes to substitute the judgement of a hospital administrator for a doctor. "You are asking the hospital administrator to make decisions," Pike told Califano, "and I will concede that he can order the thermostat turned down to save money. But what does he do if the doctors come along and say that the patients are cold? Does he overrule the doctors?"
Califano said the doctor-patient relationship is "sacred" and that the bill does not propose to interfere with it. At another point, however, he told Rostenkowski that he hoped hospital administrators would use the legislation as leverage agaist tests and equipment being ordered by doctors.
Noting that the bill is to be transitional, until more permanent and comprehensive programs can be adopted, Rep. Willis D. Gradison Jr. (R-Ohio) told Califano, "We're really being asked to buy pig in a poke . . . We'd be a lot better off knowing what the second step is going to be before we take the first step."
Speaking to reporters after his testimony, Califano predicted that the bill would pass Congress and that the administration would "propose national health insurance long before the next presidential election."