American hospital leaders opened their battle against President Carter's health cost control bill yesterday by saying it would entangle hospitals in new federal regulations and force them to ration the saving of lives.
Two top administration officials -- chief presidential economic adviser Charles L. Schultze and Health, Education and Welfare Secretary Joesph A. Califano -- called the charges untrue and deceptive.
And Sen. Edward M Kennedy (D-Mass.), in a fiery summary of the day's hearing before his Senate health subcommittee, accused the hospital spokesmen of "gross distortion" of a measure that would only curb needless and often harmful surgery, X-rays, medications and hospitalizations.
In a new development on this subcommittee he heads so forcefully, Kennedy found himself faced with an equally forceful opponent, Pennsylvania Republican Richard M Schweiker. Schweiker this year replaced New York's Jacob Javits -- a Republican but a co-sponsor of the hospital cost bill -- as the subcommittee's ranking Republican.
The bill would fight hospital inflation and inflation in general by limiting the future spending of any hospital that fails to meet the Administration's "voluntary" goal of a 9.7 percent increase in 1979.
In a hearing dramatically staged in the steeply pitched medical auditorium of the new Children's Hospital here, Schweiker made his opening statement by wheeling in a cart heaped with federal laws, regulations and bulky explanatory documents, all borrowed rowed from the a Wshington Hospital Center next door.
"There are two more shopping carts outside with District of Columbia regulations and other federal regulations affecting hospitals" Schweiker said. "How much will the new bill add to this pile?"
Califano waved a slim strip of green paper with a single phrase printed on it "This is the only added piece of information needed from hospitals if mandatory cost controls go into effect," he said. "It calls for one line -- the hospital's non-supervisory wage rate -- to be filled in. We have all the other information we need."
Califano said mandatory controls -- if needed -- would take only 100 new people in HEW and cost only $10 million a year to administer, "a real bargain when you consider" that the bill would save the federal government $21.8 billion and the American people $53.4 billion in all between 1980 and 1984.
Schweiker, dissecting the bill piece by piece, said it would give the HEW secretary 17 new pieces of authority, including the power to exempt individual hospitals from control. There is no way one person could exercise such large -- and questionable -- power without huge paperwork, Schweiker argued.
Then Michael Bromberg, executive director of the Federation of American Hospitals, said, "You'll need a dozen shopping carts just to handle the hospitals' requests for exemptions."
"If Congress passes this bill," added Bromberg, it will "scare" hospitals into adding new price increases before they are limited, spoil their present, truly volntary effort to control costs -- the president's "sole success story" against inflation -- and replace cooperation with an "adversary relationship" featuring endless court battles.
Bromberg and Alex McMahon, president of the giant American Hospital Association -- the AHA represents virtually tually all hospitals; the FAH investorowned hospitals -- agreed that the proposed bill is unneeded in view of recent hospital success in curbing spending.
Partly as a result of the hospitals' effort -- but in good part as a result of tough mandatory controls in nine states -- American hospitals increased their total spending by just 12.8 percent last year, compared with a 15.6 percent 1977 increase.
It is highly unfair, said McMahon and Bromberg, to control just one sector of the nation's widely overheated economy.
Not true, Schultze replied. "Clearly," he said, controlling hospital costs is a key in controlling inflation, since it is outracing most other could save the country's employers enough in health insurance premiums and Medicare payroll taxes to cut prices by $5 billion a year.
"Surely," he said, "that is nothing to be sneezed at," as well as a rare case where so much can be saved in one federal swoop.
Further, Schultze argued, controls are especially needed in health care because it is not a free market, but one where consumers make few choices and lay out little cash. And the choices are made by doctors who don't pay the bills, either, he added.
Schweiker and the hospital officials hammered at another point. The Carter bill would allow hospitals a one-percent-a-year increase for new services and.8 percent for population growth.
Every year, said McMahon, hospitals are caring for more people and for older people who need more services. These elements, plus new, improved services have been growing by 7 percent a year, Schweiker said. "So how can you say you will not ration health care if you allow only 1.8 percent? How can you say you won't cut somebody out of the system?"
"You're saying we can't add coronary care units and intensive care units," said Bromberg. "The American people don't know this They think we're just talking about raising our prices."
"The bill will cause a deterioration of care," McMahon claimed.
No, "we're just talking about belt-tightening" and abandoning the false idea that "more is necessarily better," said Kennedy, in a debate that will continue as other congressional committees wrestle with this legislation.