The touchy subject of physician salaries helped fuel a recent debate over a controversial piece of legislation in Florida.
While partisan politics prevented the bill-which would have offered subsidized health coverage to 1.1 million of the state's 2.5 million uninsured residents-from gaining approval before the session ended April 15, Gov. Lawton Chiles most likely will call a special session in June to reconsider the package.
During the debate, a spokesman for the Florida Medical Association suggested the state's physicians might be underpaid. The FMA official, Gerry Soud, was responding to a statement by Douglas Cook, director of the Florida Agency for Healthcare Administration, that physicians in Florida have the highest median salary in the nation. Mr. Cook said one reason for that is because the physicians are reluctant to join HMOs, which limit payments to providers.
The sparring was over a hotly contested provision in the main healthcare bill known as an "any willing provider" initiative. Such laws typically require health plans to admit any provider willing to accept the terms of participation. The FMA supports the plan, saying it will increase patient choice of physicians and access to healthcare services. Mr. Chiles, the insurance industry and several large business groups oppose it because they believe it would increase costs, decrease quality and gut managed care.
One problem the FMA has in attacking the salary statistics is that they come from the annual physician survey of the American Medical Association. The AMA ranked net physician income, after expenses and before taxes, by state in 1992.
With the national median at $148,000, Florida physicians were first at $172,000, Texas was second at $165,000, and California and Michigan were tied for third at $150,000.
Mr. Soud said the data might be skewed because only 161 Florida physicians responded to the survey. There are 28,000 physicians in Florida, with some 17,000 belonging to the FMA.
"I don't know how society determines who gets overpaid and who doesn't," Mr. Soud said. "But if you look at training, education, hours-then physicians, by some standards, may be underpaid."
Among friends. When first lady Hillary Rodham Clinton offers to pop in for a chat, be prepared for a less-than-spontaneous event.
That was one of the lessons Michael Smith, part-owner of the Canton Cafe in Canton, Md., learned last week when Mrs. Clinton stopped by to talk about-what else-healthcare reform.
When the White House initially phoned the restaurant to arrange the April 18 visit, it sounded as though it would be a lot more "low key" than it turned out to be, Mr. Smith said.
For example, he thought Mrs. Clinton would be talking to whomever happened to be dining at the cafe when she arrived. Instead, the White House asked Mr. Smith to arrange for friends, fellow small-business owners and healthcare professionals he knew to be present for the event. In an interview with a local TV station, Mr. Smith said the White House wanted to make sure there were no "mad bombers" in the group.
Later in the week, Mrs. Clinton spoke to the AFL-CIO and the Communications Workers of America. At each event, it was obvious that there was plenty of union support for healthcare reform and no hard feelings left over from the bitter rift over the North American Free Trade Agreement.
Both audiences gave Mrs. Clinton numerous standing ovations. At the meeting of the communications union, members wore shirts emblazoned "Give 'Em Health Care Hillary," and they waved hundreds of signs and placards, mobbing the first lady as she tried to exit the auditorium.
"Maybe you all could come back once a week," Mrs. Clinton joked.
Wary Wall Street. What does Wall Street think of Capitol Hill's posturing on healthcare reform? Not much, according to one healthcare analyst.
"I think this is basically all hot air," said Randall S. Huyser, a managing director and health services analyst for New York-based Furman Selz. His theory is that there won't be any "major, macro healthcare reform" produced by all the politicking.
His biggest concern is that federal healthcare reform efforts will become a "Trojan horse" for ushering in a single-payer system years from now.
He also warned that the government may resort to additional cost-shifting to solve its Medicare and Medicaid financing problems.
Mr. Huyser delivered the opening remarks at the Furman Selz managed-care and cost-containment conference last week.
Early results. OK, so maybe he isn't the best speller in politics, but former vice president and probable 1996 presidential candidate Dan Quayle is an expert at counting votes. And if the election were held this year, he knows he could count on the support of hundreds of residents at two nursing homes in the Pittsburgh area.
Mr. Quayle earlier this month received the annual Hance Award at a fund-raiser for the St. Barnabas Foundation, the charitable arm of St. Barnabas Health System, a Gibsonia, Pa.-based not-for-profit operator of several healthcare facilities. The award, named after the founder of St. Barnabas, was given to Mr. Quayle to honor his service to the country and his work promoting family values, said St. Barnabas spokeswoman Valerie Day Wilden.
Residents of St. Barnabas Nursing Home and Valencia Woods Nursing Home prepared for the former veep's visit by staffing an unofficial "Quayle for President" headquarters. The one-day event included a "vote of confidence" in Mr. Quayle and creation of a flag bearing 247 hand-stitched stars-each representing a vote for the GOP hopeful. Oh, and there were a few potatoes to be found around the Quayle headquarters, too, just for fun.
Quotable. At the Federation of American Health Systems convention this month at the Walt Disney World Dolphin Hotel, HCFA Administrator Bruce Vladeck said the setting was no big deal for him, given his usual Washington surroundings: "I encounter Mickey Mouse on almost an hourly basis."