Hospital officials seem to agree that their institutions are bearing a disproportionately high share of the cost of reforming Medicare and Medicaid.

Pieper says political reasons and the hospitals' relative lack of lobbying power have contributed to the new cost burdens.

"Hospitals are just one lobbying segment, and the requirement in Washington is to get the job done with the least amount of voter rebellion," says Pieper. "In this particular case, hospitals represent a somewhat vulnerable target."

Pieper says reducing inflationary payments by holding them to specific, targets, so-called market basket reduction, spreads the economic sacrifice evenly among all hospitals, but that this part of the Medicare reform legislation only accounts for 25 percent of the savings.

"Why does the other 75 percent fall on hospitals?" Pieper asks. "There are only a couple of hundred major teaching institutions in the country. Once again, the political ability of that group to complain are small compared to other groups, so it is a source of money that is very focused and harmful to that particular segment. I don't think the strategy is an accident."

Recognizing their susceptibility to bearing the brunt of the costs hospitals, while admitting they do not have the clout of the seniors' groups, have still been lobbying extensively in Washington.

Pieper says that officials at Partners, as well as many other teaching hospitals, have sent letters to members of Congress, personally appeared in Washington, D.C., and presented the dollar impact of the proposed cuts to all they could.

Jane H. Corlette, associate vice president for government, community and public affairs, says Harvard University does not have a direct role in lobbying on the hospitals' behalf, but does assist where it can.

"The hospitals are independent corporations," Corlette says, "but if I or anyone else at Harvard is talking to a staff person and the issue of the teaching hospitals comes up, we certainly defend those. We do keep abreast of what the positions of the hospitals are."

Massachusetts' largely Democratic Congressional delegation--including Rep. Joseph P. Kennedy, and Sens. Edward M. Kennedy '54-'56 and John Kerry--have all denounced the Republican proposals.

The Hospitals' Solution

While Harvard's teaching hospitals acknowledge that the Medicare system must be reformed, they feel that they are bearing more than their fair share of the responsibility.

Norton, for one, says he does not feel the trend of decreased government involvement in health care is prudent.

He says while most people agree that each individual should have equal access to health care without ability to pay, there doesn't seem to be a vehicle to realize that goal besides the government.

"My sense is that there needs to be better recognition that government has to be more involved in assuring a basic level of health care coverage to all of the population," Norton says.