The House yesterday unanimously asked the Carter administration to relax a little-noticed set of proposals that members fear could force the closing of hospitals all across the country.
The proposals are a set of possible health planning guidlines that, if enforced, could close one hospital bed in 10 in many parts of the nation.
Published in the Federal Register in September, they are part of a campaign to check health cost inflation. Federal officials say duplication of health facilities is one basic reason for runaway health costs.
Yesterday's House action was only the latest lesson in the painful politics of fighting health cost inflation in a day in which everyone decries rising health costs but no one wants to lose a local facility.
By a 357-to-0 vote on a resolution introduced by Rep. Berkley Bedell (D-Iowa), the House asked Health, Education and Welfare Secretary Joseph A. Califano Jr. to exempt many rural and community hospitals from the standards proposed by HEW in September.
The House action was part of what is rapidly becoming a nationwide wave of protests against the proposed standards, even though Califano and other officials say they have no power at all to close hospitals and haven't asked for any.
But the proposed HEW guidelines do suggest a limit of no more than four acute-care beds per 1,000 persons in any area. And federal officials last September said the guidelines, if followed, could eventually eliminate nearly 100,000 of the nation's 970,648 acute-care beds and save some $2 billion a year.
Such trimming, however, would have to be done by locally and state-run "health systems agencies" created by Congress in 1974 in a law that gives the agencies no such authority other than jawboning and some control of federal funds.
Nonetheless, local and national hospital ffficals widely see the 1974 law and newly proposal federal guidelines as a foot in the door that would soon lead to specific proposals for sanctions against hospitals or wards labeled "unneeded."
House Health Subcommittee Chairman Paul Rogers (D-Fla.) last month urged Califano to clarify HEW's position. In return, Califano promised to ease the proposed requirements in their final version due early next year.
But 49 senators led by Wendell Anderson (D-Minn.) and Dick Clark (D-Iowa) Monday told Califano that HEW's proposals "give us little comfort" to allay faear that "local hospitals may be in jeopardy." They asked him to "clarify and strengthen exemptions" for the small hospitals that serve "millions of Americans."
If the HEW guidelines were strictly followed, Bedell said yesterday, it would mean the closing of 25 hospitals in his Iowa district alone.
The guidelines as proposed could also shut down many obstretric wards, he added, since they suggest considering the closing of any such ward that delivered less than 500 babies a year.
"Most of our hospitals only deliver 100 or 125 babies a year," Bedell said. "But people don't want to drive 20 or 25 miles to a strange community and strange doctor. Also the driving may be impossible in winter."
Steve Cook, Bedell's press aide, said, "We've had 4,000 to 5,000 letters from our district on this issue, more than on any other issue in Rep. Bedell's two terms."
Some health officials think the letter writing is being inspired by both state hospital associations and the powerful American Hospital Association, which has called HEW's proposals unreasonable.
Rep. Rogers has blamed the nationwide furore on "misunderstanding" of the 1974 law that he helped write. But he also said last month that, while the action to close beds must be local and voluntary, not federal and compulsory, "excess beds" and ""excess equipment" must somehow be eliminated to save dollars.