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The nation's largest group of medical specialists proposed Monday a national health-care reform plan designed to control rising health care costs and provide health insurance to all Americans.

The American College of Physicians, which represents 77,000 doctors practicing internal medicine, called for a substantial restructuring of the nation's insurance industry and consolidation of Medicaid, Medicare and other government programs.The proposal comes amid a national debate on the future of the American health care system. A variety of reforms have been proposed to provide health care to at least 30 million uninsured Americans and control rapidly rising health-care costs.

"This is a plan that can provide a basis for change, especially in this election year with health care high on the political agenda," said Dr. Willis C. Maddrey, president of the group.

Under the plan, published in the group's journal, Annals of Internal Medicine, employers could offer their own health care coverage or pay a tax to enroll their workers in government programs, which would be consolidated.

A national commission would develop a national health care budget, which would be set at the current level of health care spending - $809 billion in 1992.

Doctors, hospitals and other health-care providers would negotiate fees with states, and all insurance plans would pay the same fees.

The proposal also calls for regulation of the supply of doctors and medical facilities, with incentives to increase the number of primary care doctors.

"With this proposal, our physicians acknowledge that the health care system is so broken that something much greater than incremental reform must be done to fix it," Maddrey said.

"The guiding ethic of medicine is to restore and preserve health, yet the very health care system in which we practice frustrates our efforts. Too many of our patients cannot afford the medicine or lab tests we know they need, and they speak of huge gaps in their health insurance or unmanageable premiums," he said.

The proposal is aimed at offering specific ways to implement the group's 1990 call for universal access to the health care system.

President Bush's health reform plan calls for market-based changes, including limits on malpractice suits and mandatory managed care for some people. The plan also would provide a combination of tax credits or other incentives to help individuals purchase private health insurance.

Democrat Bill Clinton proposes a variation of the "play-or-pay" plan, which requires employers to provide minimum insurance or to pay into a federal fund. The federal fund would pay for coverage of individuals who otherwise have no insurance.