Responding to the multiple dueling reform plans facing the California Legislature, the Los Angeles County Medical Association convened a task force to spell out what the association considers the most important elements of any reform. Now crystallized into 10 "Guiding Principles on Health Care Reform," LACMA hopes to popularize its perspective among the state's doctors and lawmakers.

Based on the concept of an inviolable doctor-patient relationship, the plan is designed to be widely acceptable. "What we wanted to do was get something that all the doctors could agree on--or at least 90 percent of doctors could agree on," says Paul Kirz, MD, chair of the LACMA Health Insurance Task Force. "One goal is to go to the California Medical Association and get [it] to either adopt ours or create its own," he says. "We want to take a fresh look at the whole thing."

The CMA has seen the plan, but it has not decided to endorse or reject it. LACMA has also presented its 10 points to the governor's staff. The next step, Dr. Kirz says, is to build support for the principles among Los Angeles County legislators.

The principles follow:
1. We fully support financial and fee transparency in the entire healthcare system including, but not limited to hospitals, insurance companies, government payers, pharmaceutical corporations and physicians.

2. We oppose the proposed 2 percent tax on physicians' revenues and oppose singling out any individual or group to be taxed to fund healthcare reform. We recognize that there may be a need for other funding mechanisms, including across-the-board tax increases.

3. We support increased patient access to healthcare. Providers should not be required by contract or law to provide care at a financial loss.

4. Any expansion of scope of practice for nonphysicians should require direct physician supervision.

5. We support high-deductible health insurance and health savings accounts. We favor changes in California tax law to conform to federal tax deductibility of health savings accounts.

6. We support individual tax credits, tax deductions and vouchers to encourage the purchase of health insurance.

7. We support educating the public as to the true cost of healthcare.

8. We support educating the public as to individual responsibility for healthcare and the healthcare of dependents.

9. We support cost containment only if quality of care and patient access are preserved.

10. The Medical Injury Compensation Reform Act of 1975 must be preserved.