The plan is another sign that the President is determined to use his last year in office to establish his legacy. In recent months he has increasingly bypassed Congress, using presidential orders, for instance, to create new national monuments over the complaints of mining interests and off-road-vehicle users, among others. In this case, though, rather than depend on a federal edict to enforce the changes, Clinton will urge each state to implement the revisions over three years. (Hospitals operating Medicare and other government health care programs would be immediately affected, as they are already subject to federal scrutiny). The plan seeks to safeguard patients against the ill effects of everything from doctors' notoriously illegible handwriting to missteps in everyday procedures. The most controversial aspect of full disclosure of medical mistakes has always been the tension between a patient's right to know and a health care provider's right to privacy. Under the new guidelines, hospital errors would be made public, but the identity of doctors and other hospital workers would be kept confidential — a compromise opposed by the American Medical Association and American Hospital Association, who argue such widespread exposure could pave the road for an onslaught of litigation and could thus drive health care providers to try to hide mistakes.
Experts predict this proposal will be extremely popular with voters — and widespread public support could be crucial to the success of Clinton's plan, particularly in an election year when politicians are more susceptible to constituent pressure. While the President can initiate the legislative aspects of the program without congressional approval, he will have to pitch the budget-straining components — like a $20 million pledge to found the Center for Quality Improvement and Patient Safety — to Capitol Hill.