The Doctors Take On Bush

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Doctors tend to be pretty conservative people, professionally and politically. Most counsel moderation, make good money (average yearly income: about $160,000) and look with disfavor on various schemes to nationalize health care. Not surprisingly, they often vote Republican.

But ask a doctor today how he or she feels about the current Administration and you could easily get an earful. "I'm frustrated," says Dr. Sherman Elias, director of the division of reproductive genetics at the University of Tennessee. "We're mad," says Dr. Carol Kurz, an obstetrician-gynecologist at a Los Angeles hospital. "The Bush Administration has overstepped its bounds," says Dr. Allan Rosenfield, dean of the School of Public Health at Columbia University. "And medicine is strongly and unanimously opposed to it."

What's ailing these doctors? In three words: the gag rule. Two months ago, the Supreme Court upheld a Reagan Administration ban on abortion counseling at federally funded clinics and thus permitted the type of government meddling that makes doctors most uncomfortable: restricting, based on political rather than professional considerations, what they can say to patients. Ever since, the medical establishment has been running a high fever, dashing off angry letters, signing petitions and marching in street demonstrations like any other disaffected interest group. "This is a bald-faced issue for doctors," says Dr. Marjorie Braude of the American Medical Women's Association. "It's asking us to commit malpractice."

This is not the first time the Bush Administration has run afoul of doctors. Two years ago, Louis Sullivan, the Secretary of Health and Human Services, angered medical researchers by extending a Reagan-era ban on federal funding for experiments involving fetal-tissue transplants, an important field that shows promise for treating many human disorders, including diabetes and Parkinson's disease. Ignoring the recommendations of a scientific panel, Sullivan argued that encouraging fetal-tissue research would lead to more abortions. A measure that would overturn the ban passed the House last week by nearly enough votes to override a Presidential veto. A similar provision is expected to be introduced in the Senate in August.

An issue even closer to most doctor's hearts -- and pocketbooks -- is the Medicare fee schedule proposed in late May. The Administration was directed by Congress to overhaul the fees physicians are paid to treat the 34 million elderly and disabled patients eligible for Medicare. The idea was to shift some payments from high-paid specialists to lower-paid general practitioners. But the new Administration rules went even further, cutting future Medicare payments by $3 billion and lowering reimbursements to some groups -- notably internists -- that Congress had intended to help. To make matters worse, the government issued new rules last week that will sharply restrict the circumstances under which doctors may send Medicare and Medicaid patients to clinics and out-patient services in which they have a financial stake. These investments, which have yielded rich dividends for physicians during the past decade, will now have to be restructured or withdrawn altogether.