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Health Care Reform - DPC Study on Quality, Access and Cost
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Health Care Reform - DPC Study on Quality, Access and Cost
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Records of the White House Office of Policy Development (George H. W. Bush Administration)
Johannes Kuttner Subject Files
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Originally Processed With FOIA(s):
FOIA Number:
1999-0118-F
1999-0118-F
FOIA
MARKER
This is not a textual record. This is used as an
administrative marker by the George Bush Presidential
Library Staff.
Record Group/Collection:
George H.W. Bush Presidential Records
Collection/Office of Origin: Policy Development, White House Office of
Series:
Kuttner, Johannes, Files
Subseries:
OA/ID Number:
06969
Folder ID Number:
06969-006
Folder Title:
Health Care Reform - DPC Study on Quality, Access and Cost
Stack:
Row:
Section:
Shelf:
Position:
G
0
0
0
O
Withdrawal/Redaction Sheet
(George Bush Library)
Document No.
Subject/Title of Document
Date
Restriction
Class.
and Type
01. Memo
From Charles Kolb to Roger Porter
10/15/90
P-5
Re: Tomorrow's Health Care meeting with Governor Sununu
(3 pp.)
Collection:
Record Group: Bush Presidential Records
Open on Expiration of PRA
Office:
Policy Development, Office of
(Document Follows)
Series:
Kuttner, Johannes
BYJRD (NLGB) on 1/4/2005
Subseries:
WHORM Cat.:
File Location:
Health Care Reform - DPC Study on Quality, Access, and Cost
Date Closed:
1/4/2005
OA/ID Number:
06969-006
FOIA/SYS Case #:
1999-0118-F
Appeal Case #:
Re-review Case #:
2005-0296-S
Appeal Disposition:
P-2/P-5 Review Case #:
Disposition Date:
AR Case #:
MR Case #:
AR Disposition:
MR Disposition:
AR Disposition Date:
MR Disposition Date:
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P-1 National Security Classified Information [(a)(1) of the PRA]
(b)(1) National security classified information [(b)(1) of the FOIA]
P-2 Relating to the appointment to Federal office [(a)(2) of the PRA]
(b)(2) Release would disclose internal personnel rules and practices of an
P-3 Release would violate a Federal statute [(a)(3) of the PRA]
agency [(b)(2) of the FOIA]
P-4 Release would disclose trade secrets or confidential commercial or
(b)(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
(b)(4) Release would disclose trade secrets or confidential or financial
P-5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
(b)(6) Release would constitute a clearly unwarranted invasion of
P-6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
(b)(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed of
(b)(8) Release would disclose information concerning the regulation of
gift.
financial institutions [(b)(8) of the FOIA]
(b)(9) Release would disclose geological or geophysical information
PRM. Removed as a personal record misfile.
CC: Hanno Kuttner
THE WHITE HOUSE
WASHINGTON
October 15, 1990
MEMORANDUM FOR ROGER B. PORTER
FROM:
CHARLES E.M. KOLB CEWK
SUBJECT:
Tomorrow's Health Care Meeting With Governor
Sununu
Attached is a briefing book prepared by HHS staff for tomorrow's
meeting with Governor Sununu, Mike Boskin, Dick Darman, Ede
Holiday, Secretary Sullivan, and HHS Under Secretary Connie
Horner. The subject of the meeting is to discuss the proposed
process for handling health care policy by the Administration
during the next several months. I attended a meeting this
morning with Steve Danzansky, Richard Porter, Dan Schmalensee,
Connie Horner, John Robson, Arnold Tompkin, and Bill Myers to
review the issues prior to tomorrow's session.
Connie Horner outlined how she expects tomorrow's meeting to
proceed:
(1) The Political Context -- Secretary Sullivan will probably
begin by emphasizing that the time is not ripe for a major
initiative on health care. His belief is based on comments
from Bob Teeter as well as surveys from Dick Wirthlin, Blue
Cross/Blue Shield, and Gallup. That is why he will suggest
the need for continued education and an extended timeline
for the Administration's health policy reform.
The surveys to which Sullivan will allude indicate that
while Americans (especially the elderly) generally believe
in a basic entitlement to health care, they also believe
that no more resources should be spent to provide it.
Candidly he would admit that even if we did nothing in
health policy during the next year, "the world would not
come to an end." His long-term goal, however, is to expand
access, particularly in light of the fact that insurance
company reserves are currently high by historical comparison
and that health care premiums have not been increasing as
much recently as in the past. (For example, Federal
employees' health benefits increased 4.5% this year compared
to 12% last year and 20% in 1988.) Another factor that
supports his view that there is no urgent need to decide
something major now is that one or two more years of State
- 2 -
experimenting in the health care area may well yield some
useful information. (Note: The NGA effort spearheaded by
Gov. Gardner could impact this timeframe, especially if
NGA's report comes out next summer when the Steelman report
is anticipated.)
(2) An Infant Mortality "Downpayment" -- Given no major
initiative on the horizon at least for next year, HHS will
possibly want to discuss a "downpayment" on health care
initiatives to be included in the FY 92 budget and State of
the Union. Under consideration is an initiative that would
focus on children by expanding resources to combat infant
mortality.
Since the Steelman Commission will probably postpone its
report until next summer or the early autumn of 1991, HHS
will suggest deferring decisions on more expansive proposals
to increase access to health care.
(3) What's A "Downpayment"? -- I asked Connie Horner how much
she was contemplating when she used the term "downpayment"
on infant mortality policy. She estimated an amount of $300
million to $500 million which could be used to target funds
on infant mortality disaster areas; strengthen health care
delivery systems by increasing the number of community
health centers and paying their staffs higher salaries;
increasing Medicaid enrollment through an expanded outreach
effort that would not expand Medicaid eligibility; and
targeting resources on smoking, alcohol and drug abuse among
pregnant women. Some or all of these efforts could be
funded for the $300-500 million estimate (Note: the Senate
Finance Committee and the House Energy and Commerce
Committees are reportedly considering a first-year $80
million Medicaid expansion for children by phasing in
mandatory coverage.)
Should HHS raise this point tomorrow, you might ask how they
would ensure greater accountability for outcomes by adding
in these extra funds. Is this just program expansion or are
there ways to pursue enhanced targeting and/or better
services integration to strengthen accountability?
(4) Access to Health Care -- HHS has already begun to study the
longer term issues of access to quality health care and has
under consideration a proposal that would cap or abolish the
tax exclusion for employee health benefits. This obviously
amounts to a wealth transfer to the poor from the middle
class who would fund the Medicaid expansion. One of the
rationales for doing this is that it would arguably enhance
cost containment for all participants. The tax exclusion
- 3 -
and Medicare expansion components would presumably be phased
in over several years between announcement and 2000.
This approach is somewhat less radical than the Heritage
Foundation's proposal which would completely eliminate the
State contribution to Medicaid. The HHS approach, by
contrast, would actually raise the State contribution and is
justified by HHS as the best that can be implemented in the
"current world of Washington."
Here is how it would work. Abolishing the tax exclusion for
employee health benefits would save an estimated $58.6
billion the first year. A tax credit phased in at the level
of 100% to 300% of the poverty level would cost
approximately $22.1 billion. Providing Medicaid expansions
of 75% to 100% of poverty would cost $21.8 billion
(approximately $8 billion of which comes from the States).
Subtracting these two figures from the initial savings
($58.6 billion) yields $14.7 billion left that could be
allocated (potentially) to offset the impact of ending the
tax exclusion.
Obviously, this approach hits pretty heavily on the middle
class. A family with earnings of approximately 500% of the
poverty level (i.e., $60,000 to $70,000) would pay an
additional $1140 in taxes. Politically, such a plan would
be highly controversial.
(5) Process -- Tomorrow's meeting will probably take the
following format:
Secretary Sullivan will begin by discussing the current
political context and the current efforts underway in
HHS and the Steelman Commission. He will note that
since the deadlines are longer than initially expected,
final decisions can probably wait.
He will outline his five "seminar" themes on health
care policy which will be conducted in speeches around
the country.
He will then raise the possibility of focusing on the
infant mortality issue as an effort to say something
about health care policy in the State of the Union
Address and the FY 92 budget.
Cabinet Affairs would like to avoid specifics and to
emphasize process and the need to obtain political guidance
before proceeding any further.
Attachment
THE WHITE HOUSE
washington
January 31, 1990
MEMORANDUM FOR SECRETARY SULLIVAN
FROM:
ROGER B. PORTER
DAVID Q. BATES
FoR
RBP
SUBJECT:
The President's State of the Union Address
-- Directive for Health Care Study
In the President's State of the Union Address tonight, he
plans to direct the Secretary of Health and Human Services to
review the recommendations of the health care studies now
underway that deal with health care challenges, including
improving access to health care and moderating growth in health
care costs.
The directive will ask that the Secretary's study be
presented to the President through the Domestic Policy Council.
It is important that this study review the forthcoming
reports of the Pepper Commission and the Advisory Council on
Social Security, as well as other pertinent information and
recommendations.
Please arrange for regular reports on the progress of this
study for the Domestic Policy Council through the Working Group
on Health Policy. The next working group meeting is scheduled
for Monday, February 12. The Department of Health and Human
Services should be prepared to present a study plan at that
meeting.
Your study report should include a range of options for
review by the President, through the Domestic Policy Council.
We look forward to working with you through this process.
If we may be of further assistance, do not hesitate to call on
us.
Withdrawal/Redaction Sheet
(George Bush Library)
Document No.
Subject/Title of Document
Date
Restriction
Class.
and Type
02a. Memo
From Hanns Kuttner to Roger Porter
08/03/90
P-5
Re: Health Care Study (1 pp.)
Collection:
Record Group:
Bush Presidential Records
Open on Expiration of PRA
(Document Follows)
Office:
Policy Development, Office of
By JRD (NLGB) on 1/4/2005
Series:
Kuttner, Johannes
Subseries:
WHORM Cat.:
File Location:
Health Care Reform - DPC Study on Quality, Access, and Cost
Date Closed:
1/4/2005
OA/ID Number:
06969-006
FOIA/SYS Case #:
1999-0118-F
Appeal Case #:
Re-review Case #:
2005-0296-S
Appeal Disposition:
P-2/P-5 Review Case #:
Disposition Date:
AR Case #:
MR Case #:
AR Disposition:
MR Disposition:
AR Disposition Date:
MR Disposition Date:
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P-1 National Security Classified Information [(a)(1) of the PRA]
(b)(1) National security classified information [(b)(1) of the FOIA]
P-2 Relating to the appointment to Federal office [(a)(2) of the PRA]
(b)(2) Release would disclose internal personnel rules and practices of an
P-3 Release would violate a Federal statute [(a)(3) of the PRA]
agency [(b)(2) of the FOIA]
P-4 Release would disclose trade secrets or confidential commercial or
(b)(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
(b)(4) Release would disclose trade secrets or confidential or financial
P-5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
(b)(6) Release would constitute a clearly unwarranted invasion of
P-6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
(b)(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed of
(b)(8) Release would disclose information concerning the regulation of
gift.
financial institutions [(b)(8) of the FOIA]
(b)(9) Release would disclose geological or geophysical information
PRM. Removed as a personal record misfile.
THE WHITE HOUSE
WASHINGTON
August 3, 1990
MEMORANDUM FOR ROGER B. PORTER
FROM:
HANNS KUTTNER R
SUBJECT:
Health Care Study
The form of the health care study the President requested
from Secretary Sullivan has never been made clear. Is the
Secretary to provide a comprehensive report, in the pattern of
the national transportation plan or the national energy
strategy, or is his responsibility solely to fashion options
that can be embodied in an options paper to be forwarded to the
President? These two directions are fleshed out as Option A
and Option B in the attachment.
A report which tries to cover a broad range of issues will
provide a platform for raising issues like fitness and personal
responsibility that are unlikely to be heard if the process is
solely one of internal deliberations on options that concludes
in a policy announcement and fact sheet.
Which option do you believe should be pursued?
Option A
Option B
Attachment
Withdrawal/Redaction Sheet
(George Bush Library)
Document No.
Subject/Title of Document
Date
Restriction
Class.
and Type
02b. Paper
Health Care Study - Options Paper (1 pp.)
n.d.
P-5
Collection:
Record Group: Bush Presidential Records
Open on Expiration of PRA
Office:
Policy Development, Office of
(Document Follows)
Series:
Kuttner, Johannes
By JRD (NLGB) on 1/4/2005
Subseries:
WHORM Cat.:
File Location:
Health Care Reform DPC Study on Quality, Access, and Cost
Date Closed:
1/4/2005
OA/ID Number:
06969-006
FOIA/SYS Case #:
1999-0118-F
Appeal Case #:
Re-review Case #:
2005-0296-S
Appeal Disposition:
P-2/P-5 Review Case #:
Disposition Date:
AR Case #:
MR Case #:
AR Disposition:
MR Disposition:
AR Disposition Date:
MR Disposition Date:
RESTRICTION CODES
Presidential Records Act - - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P-1 National Security Classified Information [(a)(1) of the PRA]
(b)(1) National security classified information [(b)(1) of the FOIA]
P-2 Relating to the appointment to Federal office [(a)(2) of the PRA]
(b)(2) Release would disclose internal personnel rules and practices of an
P-3 Release would violate a Federal statute [(a)(3) of the PRA]
agency [(b)(2) of the FOIA]
P-4 Release would disclose trade secrets or confidential commercial or
(b)(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
(b)(4) Release would disclose trade secrets or confidential or financial
P-5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
(b)(6) Release would constitute a clearly unwarranted invasion of
P-6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
(b)(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed of
(b)(8) Release would disclose information concerning the regulation of
gift.
financial institutions [(b)(8) of the FOIA]
(b)(9) Release would disclose geological or geophysical information
PRM. Removed as a personal record misfile.
HEALTH CARE STUDY
ISSUE: What is the "report" requested by the President in the
State of the Union address? A confidential options paper or a
publicly releasable document like the National Energy Strategy?
Option A
HHS internal task force chaired by Connie Horner completes
its report on access to health care and financing of long
term care. Possible release of paper as a public
document.
Based on this task force report, HHS prepares an options
paper for Secretary Sullivan to forward to the President
by the DPC, centered on the access issues of the Horner
report.
Working Group on Health Policy review of options paper.
DPC review of the options; recommendations to the
President; Presidential decision.
Option B
HHS internal task force completes its report.
Based on this report, HHS prepares a document appropriate
for public release that covers the quality, access, and
cost of our health care system. This document serves as
the report requested by the President in the State of the
Union address.
Preparation of an options paper by the Working Group on
Health Policy.
Review of the options paper by the DPC; recommendations to
the President; Presidential decision.
Withdrawal/Redaction Sheet
(George Bush Library)
Document No.
Subject/Title of Document
Date
Restriction
Class.
and Type
03a. Memo
From Hanns Kuttner to Roger Porter
05/28/90
P-5
Re: Progress on the Health Care Study (1 pp.)
Collection:
Record Group:
Bush Presidential Records
Open on Expiration of PRA
Office:
Policy Development, Office of
(Document Follows)
Series:
Kuttner, Johannes
BYJRD (NLGB) on 1/4/2005
Subseries:
WHORM Cat.:
File Location:
Health Care Reform - DPC Study on Quality, Access, and Cost
Date Closed:
1/4/2005
OA/ID Number:
06969-006
FOIA/SYS Case #:
1999-0118-F
Appeal Case #:
Re-review Case #:
2005-0296-S
Appeal Disposition:
P-2/P-5 Review Case #:
Disposition Date:
AR Case #:
MR Case #:
AR Disposition:
MR Disposition:
AR Disposition Date:
MR Disposition Date:
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P-1 National Security Classified Information [(a)(1) of the PRA]
(b)(1) National security classified information [(b)(1) of the FOIA]
P-2 Relating to the appointment to Federal office [(a)(2) of the PRA]
(b)(2) Release would disclose internal personnel rules and practices of an
P-3 Release would violate a Federal statute [(a)(3) of the PRA]
agency [(b)(2) of the FOIA]
P-4 Release would disclose trade secrets or confidential commercial or
(b)(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
(b)(4) Release would disclose trade secrets or confidential or financial
P-5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
(b)(6) Release would constitute a clearly unwarranted invasion of
P-6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
(b)(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed of
(b)(8) Release would disclose information concerning the regulation of
gift.
financial institutions [(b)(8) of the FOIA]
(b)(9) Release would disclose geological or geophysical information
PRM. Removed as a personal record misfile.
THE WHITE HOUSE
WASHINGTON
May 28, 1990
MEMORANDUM FOR ROGER B. PORTER
FROM:
HANNS KUTTNER K
SUBJECT:
Progress on the Health Care Study
The health care study announced in the State of the Union
address has made limited progress. This memorandum reviews
where we are and forwards lists of principles and issues.
To review where we are:
HHS has formed an internal group to consider issues
arising from the study process.
We have both a Health Policy Working Group of the DPC and
an "executive committee" of White House and key agency
staff.
One meeting involving senior officials was held in late
February. That meeting closed with a general belief that
the study process would include an early effort to
identify where the process is going; that has not
happened.
Various players in the several fora are working on their
own agenda for figuring out where we are going.
In order to meet the expectations created in the State of
the Union address, we must:
1.
Establish principles
Some principles I have drafted, as well as some
drafted at HHS, are at Tab A.
2.
Agree on principles/direction
Items to be discussed at a meeting of senior
officials to give guidance are at Tab B.
3.
Define an outcome for the study process.
Assuming we conclude the study is to go beyond access
issues, an outline for a comprehensive study is at
Tab C.
Attachments
Withdrawal/Redaction Sheet
(George Bush Library)
Document No.
Subject/Title of Document
Date
Restriction
Class.
and Type
03b. Paper
Health Principles (2 pp.)
n.d.
P-5
Collection:
Record Group:
Bush Presidential Records
Open on Expiration of PRA
Office:
Policy Development, Office of
(Document Follows)
Series:
Kuttner, Johannes
ByJRD (NLGB) on 1/4/2005
Subseries:
WHORM Cat.:
File Location:
Health Care Reform - DPC Study on Quality, Access, and Cost
Date Closed:
1/4/2005
OA/ID Number:
06969-006
FOIA/SYS Case #:
1999-0118-F
Appeal Case #:
Re-review Case #:
2005-0296-S
Appeal Disposition:
P-2/P-5 Review Case #:
Disposition Date:
AR Case #:
MR Case #:
AR Disposition:
MR Disposition:
AR Disposition Date:
MR Disposition Date:
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P-1 National Security Classified Information [(a)(1) of the PRA]
(b)(1) National security classified information [(b)(1) of the FOIA]
P-2 Relating to the appointment to Federal office [(a)(2) of the PRA]
(b)(2) Release would disclose internal personnel rules and practices of an
P-3 Release would violate a Federal statute [(a)(3) of the PRA]
agency [(b)(2) of the FOIA]
P-4 Release would disclose trade secrets or confidential commercial or
(b)(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
(b)(4) Release would disclose trade secrets or confidential or financial
P-5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
(b)(6) Release would constitute a clearly unwarranted invasion of
P-6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
(b)(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed of
(b)(8) Release would disclose information concerning the regulation of
gift.
financial institutions [(b)(8) of the FOIA]
(b)(9) Release would disclose geological or geophysical information
PRM. Removed as a personal record misfile.
Health Principles
Keywords: balance, prudence, responsibility, investment
Overall
1.
A healthier America requires more responsible Americans, a
more efficient system for delivering care, and the
availability of necessary health care for all.
2.
We must recognize mutual responsibilities:
-
that of citizens to act responsibly in making choices
that affect health and
-
that of government to educate citizens about those
choices.
3.
As a nation, we should seek a health care service delivery
system that:
-
provides all Americans with access to the health care
services necessary to well-being.
-
provides access to insurance arrangements that will
allow individuals to protect themselves from
disastrous health care expenses.
Cost
1.
Americans must become both more aware of and sensitive to
the cost of the health care they receive.
2.
Consumers must have the tools to make effective choices.
Quality
1.
We must develop an understanding of quality that does not
equate quality with the volume of services.
2.
Consumers must have the tools to make effective choices.
Principles for government action
1.
Any government effort must balance greater personal
responsibility, controlling costs, and expanding access.
An unbalanced approach can only make our problems worse,
not better.
2.
The federal government's resources for health should be
used prudently. Prudence implies:
-
Targeting assistance to those who need it most.
-
Investing wisely, using resources in the manner that
leads to the best health outcomes.
-
Not further tilting federal resources towards open
ended commitments that distort spending in favor of
health care over other public purposes.
3.
The federal government's responsibilities are:
-
to cooperate with states in providing access to those
who would otherwise lack health care.
-
to create the knowledge necessary for consumers to
act responsibly with respect to their own health and
to make the most efficient purchase of health care.
-
to assist the creation of knowledge that will make
possible more effective efforts to prevent, combat,
and cure disease.
Withdrawal/Redaction Sheet
(George Bush Library)
Document No.
Subject/Title of Document
Date
Restriction
Class.
and Type
03c. Paper
HHS Drafted Principles (1 pp.)
n.d.
B.5
Collection:
Open on Expiration of PRA
Record Group:
Bush Presidential Records
(Document Follows)
Office:
Policy Development, Office of
By JRD (NLGB) on 1/4/2005
Series:
Kuttner, Johannes
Subseries:
WHORM Cat.:
File Location:
Health Care Reform - DPC Study on Quality, Access, and Cost
Date Closed:
1/4/2005
OA/ID Number:
06969-006
FOIA/SYS Case #:
1999-0118-F
Appeal Case #:
Re-review Case #:
2005-0296-S
Appeal Disposition:
P-2/P-5 Review Case #:
Disposition Date:
AR Case #:
MR Case #:
AR Disposition:
MR Disposition:
AR Disposition Date:
MR Disposition Date:
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P-1 National Security Classified Information [(a)(1) of the PRA]
(b)(1) National security classified information [(b)(1) of the FOIA]
P-2 Relating to the appointment to Federal office [(a)(2) of the PRA]
(b)(2) Release would disclose internal personnel rules and practices of an
P-3 Release would violate a Federal statute [(a)(3) of the PRA]
agency [(b)(2) of the FOIA]
P-4 Release would disclose trade secrets or confidential commercial or
(b)(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
(b)(4) Release would disclose trade secrets or confidential or financial
P-5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
(b)(6) Release would constitute a clearly unwarranted invasion of
P-6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
(b)(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed of
(b)(8) Release would disclose information concerning the regulation of
gift.
financial institutions [(b)(8) of the FOIA]
(b)(9) Release would disclose geological or geophysical information
PRM. Removed as a personal record misfile.
HHS Drafted Principles
1.
All people should be able to obtain necessary health care,
and primary reliance for this health care should be placed
on access to insurance.
2.
Individuals should assume responsibility, as far as
possible, for the costs of their health care. Government
should concentrate resources on those most in need.
3.
Health financing and delivery designs should encourage:
caregiving and financial support by family members
for each other;
individual responsibility for health; and
community support.
4.
Methods of health care delivery and financing should
constrain the rate of growth in health care expenditures.
5.
The design of health care financing should:
promote innovation;
not adversely affect employment opportunities and
economic growth; and
promote the delivery of high-quality care in the most
cost-effective and compassionate way.
Withdrawal/Redaction Sheet
(George Bush Library)
Document No.
Subject/Title of Document
Date
Restriction
Class.
and Type
03d. Paper
Issues for a senior officials meeting (1 pp.)
n.d.
P-5
Collection:
Open on Expiration of PRA
Record Group:
Bush Presidential Records
(Document Follows)
Office:
Policy Development, Office of
BYJRD (NLGB) on 1/4/2005
Series:
Kuttner, Johannes
Subseries:
WHORM Cat.:
File Location:
Health Care Reform - DPC Study on Quality, Access, and Cost
Date Closed:
1/4/2005
OA/ID Number:
06969-006
FOIA/SYS Case #:
1999-0118-F
Appeal Case #:
Re-review Case #:
2005-0296-S
Appeal Disposition:
P-2/P-5 Review Case #:
Disposition Date:
AR Case #:
MR Case #:
AR Disposition:
MR Disposition:
AR Disposition Date:
MR Disposition Date:
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P-1 National Security Classified Information [(a)(1) of the PRA]
(b)(1) National security classified information [(b)(1) of the FOIA]
P-2 Relating to the appointment to Federal office [(a)(2) of the PRA]
(b)(2) Release would disclose internal personnel rules and practices of an
P-3 Release would violate a Federal statute [(a)(3) of the PRA]
agency [(b)(2) of the FOIA]
P-4 Release would disclose trade secrets or confidential commercial or
(b)(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
(b)(4) Release would disclose trade secrets or confidential or financial
P-5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
(b)(6) Release would constitute a clearly unwarranted invasion of
P-6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
(b)(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed of
(b)(8) Release would disclose information concerning the regulation of
gift.
financial institutions [(b)(8) of the FOIA]
(b)(9) Release would disclose geological or geophysical information
PRM. Removed as a personal record misfile.
ISSUES FOR A SENIOR OFFICIALS MEETING
I.
Current sense on mega-issues
A. Mandates
B.
Tax Code
II. Timing
A.
Radical Reform in 1991
B.
Defer Radical Reform
III. Meeting Expectations on Sullivan Study/DPC Process
A.
Ratification of "Manhattan Phonebook" Strategy
B.
Discussion of outline/chapters
Withdrawal/Redaction Sheet
(George Bush Library)
Document No.
Subject/Title of Document
Date
Restriction
Class.
and Type
03e. Paper
Outline for a Health Care Study (2 pp.)
n.d.
P-5
Collection:
Record Group:
Bush Presidential Records
Open on Expiration of PRA
Office:
Policy Development, Office of
(Document Follows)
Series:
Kuttner, Johannes
By JRD (NLGB) on 1/4/2005
Subseries:
WHORM Cat.:
File Location:
Health Care Reform - DPC Study on Quality, Access, and Cost
Date Closed:
1/4/2005
OA/ID Number:
06969-006
FOIA/SYS Case #:
1999-0118-F
Appeal Case #:
Re-review Case #:
2005-0296-S
Appeal Disposition:
P-2/P-5 Review Case #:
Disposition Date:
AR Case #:
MR Case #:
AR Disposition:
MR Disposition:
AR Disposition Date:
MR Disposition Date:
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P-1 National Security Classified Information [(a)(1) of the PRA]
(b)(1) National security classified information [(b)(1) of the FOIA]
P-2 Relating to the appointment to Federal office [(a)(2) of the PRA]
(b)(2) Release would disclose internal personnel rules and practices of an
P-3 Release would violate a Federal statute [(a)(3) of the PRA]
agency [(b)(2) of the FOIA]
P-4 Release would disclose trade secrets or confidential commercial or
(b)(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
(b)(4) Release would disclose trade secrets or confidential or financial
P-5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
(b)(6) Release would constitute a clearly unwarranted invasion of
P-6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
(b)(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed of
(b)(8) Release would disclose information concerning the regulation of
gift.
financial institutions [(b)(8) of the FOIA]
(b)(9) Release would disclose geological or geophysical information
PRM. Removed as a personal record misfile.
Outline for a Health Care Study
I.
Current Health Status of the American People
-
Lifespan
-
Incidence of disease/disability
-
Long term trends
-
Implications for an investment based approach to
allocating federal health resources: instead of
buying services, averting their need.
-
Principles for use of federal resources
II.
Preventing Disease/Promoting Health
-
Risk factors and their reduction
-
Promoting well being through healthy behaviors
III. Meeting the Challenge of Disease and Illness
A.
Access to Care
1.
The relationship of access to services and
health
2.
Relationship of insurance and access
3.
Insurance issues
-
Should all Americans have health insurance?
-
Problems faced by those without insurance:
do they need financial protection in the
form of an insurance product? If not
insured, how do they get necessary health
care services?
-
Market imperfections: information advantage of
providers, consumer insulation from prices,
sources of aversion to price-based competition
4.
Special challenges: pregnant women, rural
Americans, trauma care in large cities
B.
The cost and availability of health insurance
-
Problems of small business
-
People who are uninsurable
C.
Cost
-
Overall cost of health care: causes and
implications
-
Promoting prudent purchasing: the interaction of
federal purchases and other purchasers' efforts
to "buy smart"
-
Impact of federal subsidies for physician
training and capital investment in hospitals
-
Role of research
-
Biomedical
-
Health services
-
Antitrust issues
D.
Economy and efficiency in employer-provided health
benefits: the federal government as example
-
Details on our FEHBP proposal
E.
Quality
-
Measures
-
Improving outcomes
-
Reducing the incidence of negligence
F.
Malpractice
G.
Long Term Care
-
Campaign promises on savings vehicles
THE WHITE HOUSE
WASHINGTON
July 25, 1990
MEMORANDUM FOR ROGER B. PORTER
FROM:
HANNS KUTTNER He
SUBJECT:
Health Affairs Special Issue on Promoting Health
The Summer 1990 number of Health Affairs is devoted to
promoting health. Health Affairs is the premier policy
analysis journal on health issues.
Attached is the editor's message, where you will see he
notes that "President Bush has demonstrated his commitment to a
healthy lifestyle by all manner of athletic activities; he
should add to his impressive personal statement a federal
policy that places greater emphasis on preventing disease."
This suggests that in preparing a health strategy, as the
President suggested we are doing in his state of the union
address, an emphasis on prevention will be seen as a natural
for a George Bush-led Administration. By contrast, the
internal work going on at HHS seems to be solely about
delivering more health care. Health care is the old paradigm
health issue. Prevention is the new paradigm health issue.
However, because we have never defined the scope of the
Sullivan study announced in the state of the union, HHS has
proceeded with its self-defined concept of what the President
should get.
Attachment
HANNS-
WE WILL TAKE THE LEAD ON THIS IF NECESSARY.
PLEASE WORK WITH Jim, Biu ROPER, AND OTHERS TO
COME up WITH SOME SPECIFICS. WE NEED GOALS AND
SOME SPECIFIC POLICIES.
ROGER
From the Editor
limited role for its government in personal lives. Nevertheless, Lester
Breslow asserts in his overview essay that the time has arrived for the
United States to pursue health promotion more aggressively. He is fol-
Amidst the daily drumbeat of expressed concerns over the
lowed by James Mason, who sets out a policy framework of health pro-
uncontrolled rise in the cost of medical care in the United
motion objectives for the year 2000 that the federal government will for-
States, there is a largely ignored fact; most illnesses and pre-
mally unveil this fall. Next come a variety of papers that reflect the vast
mature death are caused by human habits of living that peo-
diversity of subject matter that comes under health promotion/disease
ple choose for themselves: alcohol and other drug abuse, to-
prevention: William DeJong and Jay Winsten on the role of the mass me-
bacco smoking, nutritional preferences, and reckless driving.
dia, Diana Chapman Walsh on alcohol policy, Kenneth Warner on well-
Experts in epidemiology and public health have concluded
ness at the worksite, Gilbert Omenn on the elderly, Sushma Palmer on
that nearly two-thirds of all illnesses and untimely deaths
the role of food and nutrition policy, and a conversation with economist
could have been prevented. Thus, preventable illness and in-
Tom Schelling. The Commentaries further underscore the diversity of
jury is a societal problem of major proportions, claiming
issues that arise in the context of health promotion: the role of physicians
some 1.3 million lives per year in the United States alone. If
by Robert Lawrence, the pursuit of healthier lifestyles among minorities
this saga is writ large, according to a new report by the World
by Herbert Nickens, and the role of grass-roots advocacy in relation to
Health Organization (WHO), an estimated 200 million peo-
this subject by Richard Couto. To pursue the prevention theme, we are
ple worldwide could die prematurely from preventable ill-
indebted to the support of The Henry J. Kaiser Family Foundation,
nesses in the 1990s, if current global trends continue. The
which has been at the cutting edge of private philanthropy in the sub-
WHO's director-general, Hiroshi Nakajima, declared in a
stantial resources it has committed to these activities. The foundation,
statement accompanying the report: "Many of the world's
under the leadership of Alvin R. Tarlov and Lawrence W. Green, has
illnesses are preventable or treatable with inexpensive vac-
pressed the belief through its grant making that much of ill health can be
cines, antibiotics or oral rehydration therapy. What is
attributed to individual behavior. As its core strategy, the foundation
needed is to mobilize the political will to make this a health-
has invested its prevention resources in the community organization
ier world." In the United States, the challenge is more than
model. That is, as Tarlov explained in the foundation's 1988 annual re-
political will; it is educating a citizenry that has come to be-
port, "to bring together large numbers of community people and local
lieve that its health status can be instantly improved by a
groups, first to obtain agreement on the importance of the problem, its
quick technological fix, rather than living more sensible
causes and possible remedies, then to take the necessary steps to resolve
lives. It also involves insisting on more appropriate behavior
the problem, and to sustain the community's will to build a better life."
from the medical profession, which society has entrusted
To the foundation's lasting credit, and in contrast to the timidity that
with the power of self-regulation. But the stronger exercise of
many like organizations demonstrate in being publicly accountable for
political leadership in promoting health is a worthy starting
the value of their projects, the Kaiser Family Foundation has granted the
point. President Bush has demonstrated his commitment to
University of Washington and the Group Health Cooperative of Puget
a healthy lifestyle by all manner of athletic activities; he
Sound nearly $2.9 million to conduct an independent evaluation of the
should add to his impressive personal statement a federal
effectiveness of Kaiser's Community Health Promotion Grants program
policy that places greater emphasis on preventing disease. To
in western states.
demonstrate the importance we attach to the subject, we are
devoting this issue of Health Affairs to it. The subject of
John K. Iglehart
health promotion/disease prevention reflects a theme that is
Editor
broader and more fraught with value-laden issues over the
proper role of government than any other we have under-
taken. As I have suggested, changing human behavior is the
heart of the matter, and perhaps no challenge is greater in a
society that so values free enterprise, individualism, and a
THE WHITE HOUSE
WASHINGTON
July 25, 1990
MEMORANDUM FOR JIM PINKERTON
FROM:
HANNS KUTTNER K
SUBJECT:
Health Affairs Special Issue on Promoting Health
The Summer 1990 number of Health Affairs is devoted to
promoting health. Health Affairs is the premier policy
analysis journal on health issues.
Attached is the editor's message, where you will see he
notes that "President Bush has demonstrated his commitment to a
healthy lifestyle by all manner of athletic activities; he
should add to his impressive personal statement a federal
policy that places greater emphasis on preventing disease."
This suggests that in preparing a health strategy, as the
President suggested we are doing in his state of the union
address, an emphasis on prevention will be seen as a natural
for a George Bush-led Administration. By contrast, the
internal work going on at HHS seems to be solely about
delivering more health care. Health care is the old paradigm
health issue. Prevention is the new paradigm health issue. We
need to make sure HHS does not set us up to pursue a debate
solely with old paradigm tools.
Attachment
7/25
see
attention.
to
cc/Hanns: I'm delighted
paying
is
of
whaterhor
word
My
Health Affairs
attached
the
with
I'll wris is kke doing 3 of F1
pre-emp had hry old Passign
that
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way
to
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bubblig Hrts I through If
From the Editor
limited role for its government in personal lives. Nevertheless, Lester
Breslow asserts in his overview essay that the time has arrived for the
United States to pursue health promotion more aggressively. He is fol-
Amidst the daily drumbeat of expressed concerns over the
lowed by James Mason, who sets out a policy framework of health pro-
uncontrolled rise in the cost of medical care in the United
motion objectives for the year 2000 that the federal government will for-
States, there is a largely ignored fact; most illnesses and pre-
mally unveil this fall. Next come a variety of papers that reflect the vast
mature death are caused by human habits of living that peo-
diversity of subject matter that comes under health promotion/disease
ple choose for themselves: alcohol and other drug abuse, to-
prevention: William DeJong and Jay Winsten on the role of the mass me-
bacco smoking, nutritional preferences, and reckless driving.
dia, Diana Chapman Walsh on alcohol policy, Kenneth Warner on well-
Experts in epidemiology and public health have concluded
ness at the worksite, Gilbert Omenn on the elderly, Sushma Palmer on
that nearly two-thirds of all illnesses and untimely deaths
the role of food and nutrition policy, and a conversation with economist
could have been prevented. Thus, preventable illness and in-
Tom Schelling. The Commentaries further underscore the diversity of
jury is a societal problem of major proportions, claiming
issues that arise in the context of health promotion: the role of physicians
some 1.3 million lives per year in the United States alone. If
by Robert Lawrence, the pursuit of healthier lifestyles among minorities
this saga is writ large, according to a new report by the World
by Herbert Nickens, and the role of grass-roots advocacy in relation to
Health Organization (WHO), an estimated 200 million peo-
this subject by Richard Couto. To pursue the prevention theme, we are
ple worldwide could die prematurely from preventable ill-
indebted to the support of The Henry J. Kaiser Family Foundation,
nesses in the 1990s, if current global trends continue. The
which has been at the cutting edge of private philanthropy in the sub-
WHO's director-general, Hiroshi Nakajima, declared in a
stantial resources it has committed to these activities. The foundation,
statement accompanying the report: "Many of the world's
under the leadership of Alvin R. Tarlov and Lawrence W. Green, has
illnesses are preventable or treatable with inexpensive vac-
pressed the belief through its grant making that much of ill health can be
cines, antibiotics or oral rehydration therapy. What is
attributed to individual behavior. As its core strategy, the foundation
needed is to mobilize the political will to make this a health-
has invested its prevention resources in the community organization
ier world." In the United States, the challenge is more than
model. That is, as Tarlov explained in the foundation's 1988 annual re-
political will; it is educating a citizenry that has come to be-
port, "to bring together large numbers of community people and local
lieve that its health status can be instantly improved by a
groups, first to obtain agreement on the importance of the problem, its
quick technological fix, rather than living more sensible
causes and possible remedies, then to take the necessary steps to resolve
lives. It also involves insisting on more appropriate behavior
the problem, and to sustain the community's will to build a better life."
from the medical profession, which society has entrusted
To the foundation's lasting credit, and in contrast to the timidity that
with the power of self-regulation. But the stronger exercise of
many like organizations demonstrate in being publicly accountable for
political leadership in promoting health is a worthy starting
the value of their projects, the Kaiser Family Foundation has granted the
point. President Bush has demonstrated his commitment to
University of Washington and the Group Health Cooperative of Puget
a healthy lifestyle by all manner of athletic activities; he
Sound nearly $2.9 million to conduct an independent evaluation of the
should add to his impressive personal statement a federal
effectiveness of Kaiser's Community Health Promotion Grants program
policy that places greater emphasis on preventing disease. To
in western states.
demonstrate the importance we attach to the subject, we are
devoting this issue of Health Affairs to it. The subject of
John K. Iglehart
health promotion/disease prevention reflects a theme that is
Editor
broader and more fraught with value-laden issues over the
proper role of government than any other we have under-
taken. As I have suggested, changing human behavior is the
heart of the matter, and perhaps no challenge is greater in a
society that so values free enterprise, individualism, and a
HPWG.
2.28.90
Insurance Status of U.S. Population
(Millions)
Employer Sponsored
145.6 (60.4%)
Medicaid
20.9 (8.7%)
Uninsured
31.1 (12.9%)
Other Private
Other Public
19.6 (8.1%)
24 (10%)
Total - 241.2 M
1987
aspe117a
CPS
The Uninsured: Employment Status
Employed
25.1 m (80.4%)
Unemployed
6.1 m (19.6%)
Total - 31.1 M
1987
aspe117c
Percent Uninsured Within Geographic Region
25
20
16.3%
15.7%
Percent Uninsured
15
9.3%
8.8%
10
5
0
Northeast
Midwest
South
West
Geographic Region
1987
aspe117j
Figure 1
Total health expenditures as a percent of gross domestic product: Selected countries,
selected years 1970-86
12
United States
10
Canada
8
Germany
Percent
Japan
6
United Kingdom
4
1970
1975
1980
1984
1985
1986
Year
SOURCE: (Schieber and Poullier, 1986; National Center for Health Statistics, 1989).
Figure 2
Utilization of physician services: Selected countries, selected years 1981-86
Canada
7.1
(1985)
Denmark
5.2
(1985)
United States
5.4
(1986)
France
7.8
(1987)
Japan
12.8
(1986)
Netherlands
5.4
(1987)
Quebec
4.6
(1985)
Germany
10.8
(1981)
United Kingdom
5.2
(1984)
0
2
4
6
8
10
12
14
16
Number of contacts per person per year
Figure 6
Income per physician in relative terms for general practitioners and all physicians:
Selected countries, selected years 1970-87
General practitioners
70
60
United States
50
Netherlands
Germany
Amount in thousands
40
Canada
30
France
United Kingdom
20
10
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
All physicians
100
Japan
United States
80
Germany
Amount in thousands
60
Canada
40
France
Denmark
20
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1 Income deflated by gross domestic product deflator is shown in U.S. dollars adjusted for 1980 purchasing power parities.
SOURCE: (Sandier, 1989).
44
Health Care Financing Review/Annual Supplement 1989
Table 1
Total and public health expenditure as a percent of gross domestic product:
Organization for Economic Cooperation and Development countries, 1975-87
Total expenditure
Public expenditure
Country
1975
1980
1985
1987
1975
1980
1985
1987
Percent
Australia
5.7
6.5
7.0
7.1
3.6
4.0
5.0
5.1
Austria
7.3
7.9
8.1
8.4
5.1
5.5
5.4
5.7
Belgium
5.8
6.6
7.2
7.2
4.6
5.4
5.5
5.5
Canada
7.3
7.4
8.4
8.6
5.6
5.6
6.4
6.5
Denmark
6.5
6.8
6.2
6.0
6.0
5.8
5.3
5.2
Finland
6.3
6.5
7.2
7.4
5.0
5.1
5.7
5.8
France
6.8
7.6
8.6
8.6
5.2
6.2
6.9
6.7
Germany
7.8
7.9
8.2
8.2
6.2
6.2
6.4
6.3
Greece
4.1
4.3
4.9
5.3
2.5
3.5
4.0
4.0
Iceland
5.9
6.4
7.3
7.8
5.3
5.7
6.4
6.9
Ireland
7.7
8.5
8.0
7.4
6.4
7.8
7.1
6.4
Italy
5.8
6.8
6.7
6.9
5.0
5.6
5.4
5.4
Japan
5.5
6.4
6.6
6.8
4.0
4.5
4.8
5.0
Luxembourg
5.7
6.8
6.7
7.5
5.2
6.3
6.0
6.9
Netherlands
7.7
8.2
8.3
8.5
5.9
6.5
6.6
6.6
New Zealand
6.4
7.2
6.6
6.9
5.4
6.0
5.6
5.7
Norway
6.7
6.6
6.4
7.5
6.4
6.5
6.1
7.4
Portugal
6.4
5.9
7.0
6.4
3.8
4.2
4.0
3.9
Spain
5.1
5.9
6.0
6.0
3.6
4.4
4.3
4.3
Sweden
8.0
9.5
9.4
9.0
7.2
8.7
8.6
8.2
Switzerland
7.0
7.3
7.7
7.7
4.8
5.0
5.2
5.2
Turkey
-
-
-
3.5
-
-
-
1.4
United Kingdom
5.5
5.8
6.0
6.1
5.0
5.2
5.2
5.3
United States
8.4
9.2
10.6
11.2
3.6
3.9
4.5
4.6
Mean
6.5
7.0
7.4
'7.3
5.0
5.5
5.7
'5.6
¹Includes Turkey. 1987 means excluding Turkey are 7.5 percent for total expenditure and 5.8 percent for public expenditure.
SOURCE: Organization for Economic Cooperation and Devel
alth Data File, 1989.
2
Table 10
Number of extracorporeal shock wave
lithotripsy units in operation: Selected
countries, May 1989
Per 1 million
Country
Total
inhabitants
Number of units
Belgium
11
1.10
Germany
57
0.93
Spain
34
0.88
Italy
48
0.84
Sweden
5
0.60
Ireland
2
0.56
Netherlands
8
0.55
France
29
0.53
Greece
5
0.50
Denmark
2
0.39
Portugal
3
0.30
United Kingdom
12
0.21
United States
225
0.88
SOURCE: Jönsson, B.: Linköping University, Linköping, Sweden, 1989.
Figure 2
Utilization of physician services: Selected countries, selected years 1981-86
Canada
(1985)
7.1
Denmark
(1985)
5.2
United States
5.4
(1986)
France
(1987)
7.8
Japan
(1986)
12.8
Netherlands
5.4
(1987)
Quebec
4.6
(1985)
Germany
(1981)
10.8
United Kingdom
(1984)
5.2
0
2
4
6
8
10
12
14
16
Number of contacts per person per year
NOTE: General practitioners and specialists are included.
SOURCES: A list of sources is provided in the "Technical note."
THE WHITE HOUSE
WASHINGTON
February 6, 1990
MEMORANDUM FOR THE VICE PRESIDENT
THE SECRETARY OF THE TREASURY
THE SECRETARY OF DEFENSE
THE SECRETARY OF AGRICULTURE
THE SECRETARY OF LABOR
THE SECRETARY OF HEALTH AND HUMAN SERVICES
THE SECRETARY OF VETERANS AFFAIRS
THE DIRECTOR OF THE OFFICE OF MANAGEMENT
AND BUDGET
THE CHAIRMAN OF THE COUNCIL OF ECONOMIC ADVISORS
THE ASSISTANT TO THE PRESIDENT FOR SCIENCE AND
TECHNOLOGY
THE ASSISTANT TO THE PRESIDENT AND SECRETARY TO
THE CABINET
THE ASSISTANT TO THE PRESIDENT FOR ECONOMIC AND
DOMESTIC POLICY
SUBJECT:
Health Policy Working Group
The Health Policy Working Group will continue, as in the
past, to coordinate health policy and formulate policy options
for consideration by the Domestic Policy Council. In addition,
the President stated in his State of the Union address that the
Secretary of Health and Human Services will lead a Domestic
Policy Council review of recommendations on the quality,
accessibility and cost of our nation's health care system.
The Secretary of Health and Human Services or his designated
representative will chair the Health Policy Working Group.
Working Group activities will be coordinated with the Executive
Secretary to the Domestic Policy Council.
Please advise Sara Sumner (456-6722) if you wish to continue
to be represented on this Working Group. Please also forward to
Sara the name of your agency's representative, at the Assistant
Secretary level or above, by the close of business on Monday,
February 12, 1990.
Thank you very much for your cooperation.
Dial J
Tempore
Domestic Council
- 5 -
it assures that future benefits will be funded as well. The last
thing we need to do is mess around with Social Security. (Applause.)
There's one more problem we need to address. We must
give careful consideration to the recommendations of the health care
studies underway now. That's why tonight, I'm asking Dr. Sullivan --
Lou Sullivan -- Secretary of Health and Human Services, to lead a
Domestic Policy Council review of recommendations on the quality,
accessibility and cost of our nation's health care system. I am
committed to bring the staggering costs of health care under control.
(Applause.)
The "state of the government", does indeed depend on many
of us in this very chamber. But the state of the Union depends on
all Americans. We must maintain the democratic decency that makes a
nation out of millions of individuals. I've been appalled at the
recent mail bombings across this country. Every one of us must
confront and condemn racism, antisemitism, bigotry and hate. Not
next week, not tomorrow, but right now -- every single one of us.
(Applause.)
The state of the Union depends on whether we help our
neighbor -- claim the problems of our community as our own. We've
got to step forward when there's trouble -- lend a hand, be what I
call a point of light to a stranger in need. We've got to take the
time after a busy day to sit down and read with our kids. Help them
with their homework. Pass along the values we learned as children.
That's how we sustain the state of the Union. Every effort is
important. It all adds up -- it's doing the things that give
democracy meaning. It all adds up to who we are and who we will be.
Let me say, that so long as we remember the American idea
-- so long as we live up to the American ideal -- the state of the
Union will remain sound and strong.
And to those who worry that we've lost our way -- well, I
want you to listen to parts of a letter written by James Markwell --
Private First Class James Markwell, a 20-year old Army medic of the
1st Battalion, 75th Rangers. It's dated December 18th -- the night
before our Armed Forces went into action in Panama. It's a letter
servicemen write -- and hope will never be sent. And sadly, Private
Markwell's mother did receive this letter. She passed it along to me
out there in Cincinnati.
And here is some of what he wrote: "I've never been
afraid of death, but I know he is waiting at the corner. I've been
trained to kill and to save, and so has everyone else. I am
frightened what lays beyond the fog, and yet, do not mourn for me.
Revel in the life that I have died to give you. But most of all,
don't forget the Army was my choice. Something that I wanted to do.
"Remember I joined the Army to serve my country and
insure that you are free to do what you want and live your lives
freely."
Let me add that Private Markwell was among the first to
see battle in Panama, and one of the first to fall.
But he knew what he believed in. He carried the idea we
call America in his heart.
I began tonight speaking about the changes we've seen
this past year. There is a new world of challenges and opportunities
before us. And there's a need for leadership that only America can
provide.
Nearly 40 years ago, in his last address to the Congress,
President Harry Truman predicted such a time would come. He said:
"As our world grows stronger, more united, more attractive to men on
both sides of the Iron Curtain, then inevitably there will come a
time of change within the communist world."
MORE
-9-
B.
Health Care Reform
The President directed Secretary of Health and Human Services Sullivan to review the
recommendations of the health care studies now underway that deal with health care
challenges, including improving access to health care and moderating growth in health
care costs. The Secretary's study will be presented to the President through the
Domestic Policy Council.
C.
A Commitment to Civil Rights For Every American
The President called on all citizens to confront and condemn racism, anti-semitism,
bigotry, and hate.
The President is dedicated to the principle that the enjoyment of basic civil rights is
the birthright of every American. Each citizen must have the opportunity to go as far
as his or her abilities and ambition will allow. In 1990, the President will work for:
Passage of the Americans with Disabilities Act to extend to the disabled the
laws. civil rights already guaranteed to millions of Americans by existing civil rights
Strengthening of the Civil Rights Act of 1968, as it relates to the interference
by force, or threat of force, with an individual who is exercising, or
encouraging others to exercise, rights protected by the Fair Housing Act.
Quick action by the Congress on the Hate Crimes Statistics Act.
D.
Child Care
Parental choice is the core of the President's approach to child care. The President
called for action on legislation to implement the child care plan he advanced last year.
The President's plan includes a new child tax credit that would provide for a
refundable credit of up to $1,000 per child under age four for low-income working
families and make the current Dependent Care Tax Credit refundable to taxpayers who
have no tax liability.
While flexible on the legislative details, acceptable legislation must reflect the
President's four principles: parental choice, non-discrimination against parents who
work at home, offering parents the fullest range of choices, and targeting assistance to
those who need it most.
E.
H.O.P.E.
The President has put forward a comprehensive agenda of Homeownership and
Opportunity for People Everywhere, in order to bring basic shelter and affordable
housing within the reach of millions of Americans. Elements of H.O.P.E. include:
KNOWN HEALTH EVENTS ON THE HORIZON
1990
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEPT
OCT
NOV
DEC
X
X
X
X
X
X
X
X
X
X
X
X
X
State of the
Pepper Commission
Steelman Commission
HHS Internal Task
Steelman Commission
Union (Call
(Long-Term Care)
(Health Care Reform
Force Interim Report
(Social Security
for review of
Report
Report)
to Secretary Sullivan
Report)
Nation's health
(Statistical data in
care system)
health coverage)
NCHSR: National
Infant Mortality
Medical Expenditure
Task Force Cost
Commerce/HCFA
Data Survey (Total
and Effectiveness
Congressional
Health Care
annual expenditures
Analysis of Various
Reconciliation Bill
Expenditure
for various income
Health System Reforms
Estimates
levels/geographic data)
OPM Report to
Labor Commission
Congress on
on Health Benefits
Federal Employee
in Coal Industry
Health Benefits
Program Reform
National Medical
Expenditure Survey
Treasury Tax
Data after being
Report (Tax Cap
massaged (Will clarify
Benefits and
number of uninsured)
Federal Financing
of Long-Term Care)
Agency Budget Submissions
to OMB
House Labor-Management Subcommittee
NCHSR: National Medical Expenditure
to Makeup the Access to Health Care
Data Survey (Total out-of-pocket
Bill (HR 1845)
health expenditures)
Withdrawal/Redaction Sheet
(George Bush Library)
Document No.
Subject/Title of Document
Date
Restriction
Class.
and Type
04a. Memo
From Hanns Kuttner to Roger Porter
02/01/90
P.5
Re: Meeting on Secretary Sullivan's Health Care Review (1
pp.)
Collection:
Record Group:
Bush Presidential Records
Open on Expiration of PRA
Office:
Policy Development, Office of
(Document Follows)
Series:
Kuttner, Johannes
By /JRD (NLGB) on 1/4/2005
Subseries:
WHORM Cat.:
File Location:
Health Care Reform - DPC Study on Quality, Access, and Cost
Date Closed:
1/4/2005
OA/ID Number:
06969-006
FOIA/SYS Case #:
1999-0118-F
Appeal Case #:
Re-review Case #:
2005-0296-S
Appeal Disposition:
P-2/P-5 Review Case #:
Disposition Date:
AR Case #:
MR Case #:
AR Disposition:
MR Disposition:
AR Disposition Date:
MR Disposition Date:
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P-1 National Security Classified Information [(a)(1) of the PRA]
(b)(1) National security classified information [(b)(1) of the FOIA]
P-2 Relating to the appointment to Federal office [(a)(2) of the PRA]
(b)(2) Release would disclose internal personnel rules and practices of an
P-3 Release would violate a Federal statute [(a)(3) of the PRA]
agency [(b)(2) of the FOIA]
P-4 Release would disclose trade secrets or confidential commercial or
(b)(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
(b)(4) Release would disclose trade secrets or confidential or financial
P-5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
(b)(6) Release would constitute a clearly unwarranted invasion of
P-6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
(b)(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed of
(b)(8) Release would disclose information concerning the regulation of
gift.
financial institutions [(b)(8) of the FOIA]
(b)(9) Release would disclose geological or geophysical information
PRM. Removed as a personal record misfile.
THE WHITE HOUSE
WASHINGTON
February 1, 1990
MEMORANDUM FOR ROGER B. PORTER
FROM:
HANNS KUTTNER H.K.
SUBJECT:
Meeting on Secretary Sullivan's Health Care
Review
Before Bill left, we discussed holding a meeting
involving all those perceive themselves as players on the
health care review Secretary Sullivan will conduct to
produce common expectations of how this process will work.
Without such an organizational meeting we risk chaos; I
already have the sense that more than one party perceives
him/herself as really in charge of the exercise.
The principals of the meeting would be yourself as
the chair, David Bates, Secretary Sullivan, and Under
Secretary Horner. Other attendees would be Bill Roper,
myself, Ken Yale, Dan Heimbach, Arnold Tompkins (co-
ordinator of the HHS staff doing the extant HHS internal
review), and Tom Scully to represent OMB. Key issues to
discuss would be a tentative timetable and reinforcement
of the word options.
Recommendation
I recommend that you discuss this matter with David
Bates and after consultation with him, call such a
meeting. I will prepare a set of talking points to
explain how the process will work and, after your
approval, work for a consensus at the staff level to be
ratified by the principals at the meeting.
Withdrawal/Redaction Sheet
(George Bush Library)
Document No.
Subject/Title of Document
Date
Restriction
Class.
and Type
04b. Memo
From Michael Klausner to Roger Porter
02/01/90
(b)(6)
Re: Remaining Visits (1 pp.)
Collection:
Record Group:
Bush Presidential Records
Office:
Policy Development, Office of
Series:
Kuttner, Johannes
Subseries:
WHORM Cat.:
File Location:
Health Care Reform - DPC Study on Quality, Access, and Cost
Date Closed:
1/4/2005
OA/ID Number:
06969-006
FOIA/SYS Case #:
1999-0118-F
Appeal Case #:
Re-review Case #:
2005-0296-S
Appeal Disposition:
P-2/P-5 Review Case #:
Disposition Date:
AR Case #:
MR Case #:
AR Disposition:
MR Disposition:
AR Disposition Date:
MR Disposition Date:
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P-1 National Security Classified Information [(a)(1) of the PRA]
(b)(1) National security classified information [(b)(1) of the FOIA]
P-2 Relating to the appointment to Federal office [(a)(2) of the PRA]
(b)(2) Release would disclose internal personnel rules and practices of an
P-3 Release would violate a Federal statute [(a)(3) of the PRA]
agency [(b)(2) of the FOIA]
P-4 Release would disclose trade secrets or confidential commercial or
(b)(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
(b)(4) Release would disclose trade secrets or confidential or financial
P-5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
(b)(6) Release would constitute a clearly unwarranted invasion of
P-6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
(b)(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed of
(b)(8) Release would disclose information concerning the regulation of
gift.
financial institutions [(b)(8) of the FOIA]
(b)(9) Release would disclose geological or geophysical information
PRM. Removed as a personal record misfile.
Withdrawal/Redaction Sheet
(George Bush Library)
Document No.
Subject/Title of Document
Date
Restriction
Class.
and Type
05. Memo
From Hanns Kuttner to Roger Porter
02/01/90
P.5
Re: Meeting on Secretary Sullivan's Health Care Review (1
pp.)
Collection:
Record Group:
Bush Presidential Records
Open on Expiration of PRA
Office:
Policy Development, Office of
(Document Follows)
Series:
Kuttner, Johannes
By JRD (NLGB) on 1/4/2005
Subseries:
WHORM Cat.:
File Location:
Health Care Reform - DPC Study on Quality, Access, and Cost
Date Closed:
1/4/2005
OA/ID Number:
06969-006
FOIA/SYS Case #:
1999-0118-F
Appeal Case #:
Re-review Case #:
2005-0296-S
Appeal Disposition:
P-2/P-5 Review Case #:
Disposition Date:
AR Case #:
MR Case #:
AR Disposition:
MR Disposition:
AR Disposition Date:
MR Disposition Date:
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P-1 National Security Classified Information [(a)(1) of the PRA]
(b)(1) National security classified information [(b)(1) of the FOIA]
P-2 Relating to the appointment to Federal office [(a)(2) of the PRA]
(b)(2) Release would disclose internal personnel rules and practices of an
P-3 Release would violate a Federal statute [(a)(3) of the PRA]
agency [(b)(2) of the FOIA]
P-4 Release would disclose trade secrets or confidential commercial or
(b)(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
(b)(4) Release would disclose trade secrets or confidential or financial
P-5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
(b)(6) Release would constitute a clearly unwarranted invasion of
P-6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
(b)(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed of
(b)(8) Release would disclose information concerning the regulation of
gift.
financial institutions [(b)(8) of the FOIA]
(b)(9) Release would disclose geological or geophysical information
PRM. Removed as a personal record misfile.
THE WHITE HOUSE
WASHINGTON
February 1, 1990
MEMORANDUM FOR ROGER B. PORTER
FROM:
HANNS KUTTNER H.K.
SUBJECT:
Meeting on Secretary Sullivan's Health Care
Review
Before Bill left, we discussed holding a meeting
involving all those perceive themselves as players on the
health care review Secretary Sullivan will conduct to
produce common expectations of how this process will work.
Without such an organizational meeting we risk chaos; I
already have the sense that more than one party perceives
him/herself as really in charge of the exercise.
The principals of the meeting would be yourself as
the chair, David Bates, Secretary Sullivan, and Under
Secretary Horner. Other attendees would be Bill Roper,
myself, Ken Yale, Dan Heimbach, Arnold Tompkins (co-
ordinator of the HHS staff doing the extant HHS internal
review), and Tom Scully to represent OMB. Key issues to
discuss would be a tentative timetable and reinforcement
of the word options.
Recommendation
I recommend that you discuss this matter with David
Bates and after consultation with him, call such a
meeting. I will prepare a set of talking points to
explain how the process will work and, after your
approval, work for a consensus at the staff level to be
ratified by the principals at the meeting.
them-
Like what
mind about here the and
longe
2-2-90
Withdrawal/Redaction Sheet
(George Bush Library)
Document No.
Subject/Title of Document
Date
Restriction
Class.
and Type
06a. Memo
From Hanns Kuttner to Roger Porter
02/01/90
P-5
Re: Meeting on Secretary Sullivan's Health Care Review (1
pp.)
Collection:
Open on Expiration of PRA
Record Group:
Bush Presidential Records
(Document Follows)
Office:
Policy Development, Office of
By JRD (NLGB) on 1/4/2005
Series:
Kuttner, Johannes
Subseries:
WHORM Cat.:
File Location:
Health Care Reform DPC Study on Quality, Access, and Cost
Date Closed:
1/4/2005
OA/ID Number:
06969-006
FOIA/SYS Case #:
1999-0118-F
Appeal Case #:
Re-review Case #:
2005-0296-S
Appeal Disposition:
P-2/P-5 Review Case #:
Disposition Date:
AR Case #:
MR Case #:
AR Disposition:
MR Disposition:
AR Disposition Date:
MR Disposition Date:
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P-1 National Security Classified Information [(a)(1) of the PRA]
(b)(1) National security classified information [(b)(1) of the FOIA]
P-2 Relating to the appointment to Federal office [(a)(2) of the PRA]
(b)(2) Release would disclose internal personnel rules and practices of an
P-3 Release would violate a Federal statute [(a)(3) of the PRA]
agency [(b)(2) of the FOIA]
P-4 Release would disclose trade secrets or confidential commercial or
(b)(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
(b)(4) Release would disclose trade secrets or confidential or financial
P-5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
(b)(6) Release would constitute a clearly unwarranted invasion of
P-6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
(b)(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed of
(b)(8) Release would disclose information concerning the regulation of
gift.
financial institutions [(b)(8) of the FOIA]
(b)(9) Release would disclose geological or geophysical information
PRM. Removed as a personal record misfile.
THE WHITE HOUSE
WASHINGTON
February 1, 1990
MEMORANDUM FOR ROGER B. PORTER
FROM:
HANNS KUTTNER H.K.
SUBJECT:
Secretary Sullivan's Health Care Study
Secretary Sullivan testifies next week before the
House Ways and Means Committee as part of a budget
overview hearing. His testimony, now in clearance,
obviously contains no reference to the President's
assignment in the state of the union address. HHS has
asked for guidance on how the Secretary should explain the
assignment to the committee.
A proposed insert on this subject is attached for
your review. OMB would like to complete the clearance
process by mid-day tomorrow.
Recommendation
That you review and revise the insert and return it
to me for submission to OMB.
Attachment
Withdrawal/Redaction Sheet
(George Bush Library)
Document No.
Subject/Title of Document
Date
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and Type
06b. Paper
Insert on Health Care Study (1 pp.)
n.d.
P-5
Collection:
Record Group:
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Open on Expiration of PRA
Office:
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(Document Follows)
Series:
Kuttner, Johannes
By JRD (NLGB) on 1/4/2005
Subseries:
WHORM Cat.:
File Location:
Health Care Reform - DPC Study on Quality, Access, and Cost
Date Closed:
1/4/2005
OA/ID Number:
06969-006
FOIA/SYS Case #:
1999-0118-F
Appeal Case #:
Re-review Case #:
2005-0296-S
Appeal Disposition:
P-2/P-5 Review Case #:
Disposition Date:
AR Case #:
MR Case #:
AR Disposition:
MR Disposition:
AR Disposition Date:
MR Disposition Date:
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P-1 National Security Classified Information [(a)(1) of the PRA]
(b)(1) National security classified information [(b)(1) of the FOIA]
P-2 Relating to the appointment to Federal office [(a)(2) of the PRA]
(b)(2) Release would disclose internal personnel rules and practices of an
P-3 Release would violate a Federal statute [(a)(3) of the PRA]
agency [(b)(2) of the FOIA]
P-4 Release would disclose trade secrets or confidential commercial or
(b)(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
(b)(4) Release would disclose trade secrets or confidential or financial
P-5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
(b)(6) Release would constitute a clearly unwarranted invasion of
P-6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
(b)(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed of
(b)(8) Release would disclose information concerning the regulation of
gift.
financial institutions [(b)(8) of the FOIA]
(b)(9) Release would disclose geological or geophysical information
PRM. Removed as a personal record misfile.
Insert on Health Care Study
Also part of our program for the coming year is a
review of the means by which we may address the quality
and accessibility and cost of our nation's health care
system. The President charged me in his State of the
Union address with leading a review of the recommendations
being made in the several health care studies underway and
recently completed. Several of you are aware of this
activity through your service on the U.S. Bipartisan
Commission on Comprehensive Health Care. This review will
lead to the consideration of options by the President.
Quality, accessibility and cost are not a list of
separate issues. They are one issue. As I conduct this
review I look forward to the cooperation of this Committee
and others who are devoted to improving the health of the
Nation to make the American people aware of the
significance of this issue and their stake in it. For
without the understanding of the American people, progress
will not be possible.
Withdrawal/Redaction Sheet
(George Bush Library)
Document No.
Subject/Title of Document
Date
Restriction
Class.
and Type
07a. Memo
From Hanns Kuttner to Roger Porter
02/07/90
P-5
Re: Health Care Policy Review (1 pp.)
Collection:
Open on Expiration of PRA
Record Group:
Bush Presidential Records
(Document Follows)
Office:
Policy Development, Office of
By JRD (NLGB) on 1/4/2005
Series:
Kuttner, Johannes
Subseries:
WHORM Cat.:
File Location:
Health Care Reform - DPC Study on Quality, Access, and Cost
Date Closed:
1/4/2005
OA/ID Number:
06969-006
FOIA/SYS Case #:
1999-0118-F
Appeal Case #:
Re-review Case #:
2005-0296-S
Appeal Disposition:
P-2/P-5 Review Case #:
Disposition Date:
AR Case #:
MR Case #:
AR Disposition:
MR Disposition:
AR Disposition Date:
MR Disposition Date:
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P-1 National Security Classified Information [(a)(1) of the PRA]
(b)(1) National security classified information [(b)(1) of the FOIA]
P-2 Relating to the appointment to Federal office [(a)(2) of the PRA]
(b)(2) Release would disclose internal personnel rules and practices of an
P-3 Release would violate a Federal statute [(a)(3) of the PRA]
agency [(b)(2) of the FOIA]
P-4 Release would disclose trade secrets or confidential commercial or
(b)(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
(b)(4) Release would disclose trade secrets or confidential or financial
P-5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
(b)(6) Release would constitute a clearly unwarranted invasion of
P-6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
(b)(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed of
(b)(8) Release would disclose information concerning the regulation of
gift.
financial institutions [(b)(8) of the FOIA]
(b)(9) Release would disclose geological or geophysical information
PRM. Removed as a personal record misfile.
THE WHITE HOUSE
WASHINGTON
February 7, 1990
MEMORANDUM FOR ROGER B. PORTER
FROM:
HANNS KUTTNER
SUBJECT:
Health Care Policy Review
The Domestic Policy Council review of recommendations on the
quality, accessibility and cost of our nation's health care
system began this afternoon with a meeting in Steve Danzansky's
office.
In attendance were Steve Danzansky, Ken Yale, myself, Bill
Diefenderfer and Frank Hodsoll from OMB, Hollis McLaughlin from
Treasury, Bill Myers from the Attorney General's office, and
Connie Horner and Arnold Tompkins from HHS.
Ken began by passing out a memorandum from the Attorney
General re-chartering the Health Policy Working Group.
The meeting focused on identifying where all the studies the
President alluded to stand. Connie Horner, as the new chair of
the Health Policy Working Group, plans meetings with some of
those responsible for the studies. The notion that some of these
individuals might present to the Domestic Policy Council was
favorably received. Hollis McLaughlin discussed a report to
Congress Treasury owes on the tax code and long-term care.
Connie indicated she was not familiar with the study. Upon
expression of concern that Treasury be advised as to whether or
not the working group wished to review the report, Connie
promised to give it her earliest attention.
Ken Yale had characterized the meeting as a strategy session
in his invitation to me. Steve Danzansky elaborated on this,
saying the group would serve as a "deputies committee" to keep
the critical organizations in synch on critical events. Steve
noted the need to keep meetings quiet and private in response to
Bill Myers' noting that the Attorney General has heard complaints
from Cabinet members that "my guy was not in on the deal" and
that the Attorney General expected the working group to be the
forum for the substantive conisderation of issues.
Attachment
Withdrawal/Redaction Sheet
(George Bush Library)
Document No.
Subject/Title of Document
Date
Restriction
Class.
and Type
07b. Memo
From Dick Thornburgh to Distribution
02/06/90
P-5
Re: Health Policy Working Group (1 pp.)
Collection:
Open on Expiration of PRA
Record Group:
Bush Presidential Records
(Document Follows)
Office:
Policy Development, Office of
By JRD (NLGB) on 1/4/2005
Series:
Kuttner, Johannes
Subseries:
WHORM Cat.:
File Location:
Health Care Reform - DPC Study on Quality, Access, and Cost
Date Closed:
1/4/2005
OA/ID Number:
06969-006
FOIA/SYS Case #:
1999-0118-F
Appeal Case #:
Re-review Case #:
2005-0296-S
Appeal Disposition:
P-2/P-5 Review Case #:
Disposition Date:
AR Case #:
MR Case #:
AR Disposition:
MR Disposition:
AR Disposition Date:
MR Disposition Date:
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P-1 National Security Classified Information [(a)(1) of the PRA]
(b)(1) National security classified information [(b)(1) of the FOIA]
P-2 Relating to the appointment to Federal office [(a)(2) of the PRA]
(b)(2) Release would disclose internal personnel rules and practices of an
P-3 Release would violate a Federal statute [(a)(3) of the PRA]
agency [(b)(2) of the FOIA]
P-4 Release would disclose trade secrets or confidential commercial or
(b)(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
(b)(4) Release would disclose trade secrets or confidential or financial
P-5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
(b)(6) Release would constitute a clearly unwarranted invasion of
P-6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
(b)(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed of
(b)(8) Release would disclose information concerning the regulation of
gift.
financial institutions [(b)(8) of the FOIA]
(b)(9) Release would disclose geological or geophysical information
PRM. Removed as a personal record misfile.
THE WHITE HOUSE
WASHINGTON
February 6, 1990
MEMORANDUM FOR THE VICE PRESIDENT
THE SECRETARY OF THE TREASURY
THE SECRETARY OF DEFENSE
THE SECRETARY OF AGRICULTURE
THE SECRETARY OF LABOR
THE SECRETARY OF HEALTH AND HUMAN SERVICES
THE SECRETARY OF VETERANS AFFAIRS
THE DIRECTOR OF THE OFFICE OF MANAGEMENT
AND BUDGET
THE CHAIRMAN OF THE COUNCIL OF ECONOMIC ADVISORS
THE ASSISTANT TO THE PRESIDENT FOR SCIENCE AND
TECHNOLOGY
THE ASSISTANT TO THE PRESIDENT AND SECRETARY TO
THE CABINET
THE ASSISTANT TO THE PRESIDENT FOR ECONOMIC AND
DOMESTIC POLICY
SUBJECT:
Health Policy Working Group
The Health Policy Working Group will continue, as in the
past, to coordinate health policy and formulate policy options
for consideration by the Domestic Policy Council. In addition,
the President stated in his State of the Union address that the
Secretary of Health and Human Services will lead a Domestic
Policy Council review of recommendations on the quality,
accessibility and cost of our nation's health care system.
The Secretary of Health and Human Services or his designated
representative will chair the Health Policy Working Group.
Working Group activities will be coordinated with the Executive
Secretary to the Domestic Policy Council.
Please advise Sara Sumner (456-6722) if you wish to continue
to be represented on this Working Group. Please also forward to
Sara the name of your agency's representative, at the Assistant
Secretary level or above, by the close of business on Monday,
February 12, 1990.
Thank you very much for your cooperation.
Dick Thornburgh
Chairman Pro Tempore
Domestic Policy Council
Chip Yost D after 3 years with Hofman LaRoche - goes to Treasury
where we're been/where we in going.
- report written by Jun Duggan
'Where we are / how we got here
purpose: his Sid Jones a suise of where we
are.
a few specifics
Allied Signal
- unsatigied employees.
- georg up Dr. X.
-
Hofman LaRoche
port catastrophic - planned to restructure - get our
of reponsibiling where cat backs in
now back to old Man.
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2/15
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Hown jet teather Hours
Withdrawal/Redaction Sheet
(George Bush Library)
Document No.
Subject/Title of Document
Date
Restriction
Class.
and Type
08a. Memo
From Roger Porter to Jim Muir
02/02/90
P-5
Re: HHS Testimony: Secretary Sullivan and the Health Care
Study (1 pp.)
Collection:
Open on Expiration of PRA
Record Group:
Bush Presidential Records
(Document Follows)
Office:
Policy Development, Office of
By JRD (NLGB) on 1/4/2005
Series:
Kuttner, Johannes
Subseries:
WHORM Cat.:
File Location:
Health Care Reform - DPC Study on Quality, Access, and Cost
Date Closed:
1/4/2005
OA/ID Number:
06969-006
FOIA/SYS Case #:
1999-0118-F
Appeal Case #:
Re-review Case #:
2005-0296-S
Appeal Disposition:
P-2/P-5 Review Case #:
Disposition Date:
AR Case #:
MR Case #:
AR Disposition:
MR Disposition:
AR Disposition Date:
MR Disposition Date:
RESTRICTION CODES
Presidential Records Act - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P-1 National Security Classified Information [(a)(1) of the PRA]
(b)(1) National security classified information [(b)(1) of the FOIA]
P-2 Relating to the appointment to Federal office [(a)(2) of the PRA]
(b)(2) Release would disclose internal personnel rules and practices of an
P-3 Release would violate a Federal statute [(a)(3) of the PRA]
agency [(b)(2) of the FOIA]
P-4 Release would disclose trade secrets or confidential commercial or
(b)(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
(b)(4) Release would disclose trade secrets or confidential or financial
P-5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
(b)(6) Release would constitute a clearly unwarranted invasion of
P-6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
(b)(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed of
(b)(8) Release would disclose information concerning the regulation of
gift.
financial institutions [(b)(8) of the FOIA]
(b)(9) Release would disclose geological or geophysical information
PRM. Removed as a personal record misfile.
THE WHITE HOUSE
WASHINGTON
February 2, 1990
MEMORANDUM FOR JIM MUIR
FROM:
ROGER B. PORTER
RBP
SUBJECT:
HHS Testimony: Secretary Sullivan and the
Health Care Study
Hanns Kuttner informs me that HHS has asked for guidance on
how the Secretary should explain the assignment the President
gave him in his State of the Union Address Wednesday night with
respect to his testimony next week before the House Ways and
Means Committee.
He should emphasize:
1. That he has been asked to review the recommendations
coming from the Pepper Commission, the Steelman Commission, and
other studies now underway. This obviates the need for us to
respond in detail when these recommendations are produced in the
spring and the summer.
2. HHS will also lead an interagency Domestic Policy
Council review that will study such issues as cost, access, and
quality.
3. There is no timetable or expected completion date. We
do not want to tie ourselves down to some arbitrary date with a
set of expectations. In my view he does not need to include this
in his written testimony. It can come out in answer to
questions.
If you have any questions, or we can help in any other way,
please let me know.
A possible insert that Hanns Kuttner drafted is attached
that may be of some use. If you have any questions, please
contact him directly.
Attachment
CC: Hanns Kuttner
Withdrawal/Redaction Sheet
(George Bush Library)
Document No.
Subject/Title of Document
Date
Restriction
Class.
and Type
08b. Paper
Insert on Health Care Study (1 pp.)
n.d.
P-5
Collection:
Open on Expiration of PRA
Record Group:
Bush Presidential Records
(Document Follows)
Office:
Policy Development, Office of
By JRD (NLGB) on 1/4/2005
Series:
Kuttner, Johannes
Subseries:
WHORM Cat.:
File Location:
Health Care Reform - DPC Study on Quality, Access, and Cost
Date Closed:
1/4/2005
OA/ID Number:
06969-006
FOIA/SYS Case #:
1999-0118-F
Appeal Case #:
Re-review Case #:
2005-0296-S
Appeal Disposition:
P-2/P-5 Review Case #:
Disposition Date:
AR Case #:
MR Case #:
AR Disposition:
MR Disposition:
AR Disposition Date:
MR Disposition Date:
RESTRICTION CODES
Presidential Records Act - - [44 U.S.C. 2204(a)]
Freedom of Information Act - [5 U.S.C. 552(b)]
P-1 National Security Classified Information [(a)(1) of the PRA]
(b)(1) National security classified information [(b)(1) of the FOIA]
P-2 Relating to the appointment to Federal office [(a)(2) of the PRA]
(b)(2) Release would disclose internal personnel rules and practices of an
P-3 Release would violate a Federal statute [(a)(3) of the PRA]
agency [(b)(2) of the FOIA]
P-4 Release would disclose trade secrets or confidential commercial or
(b)(3) Release would violate a Federal statute [(b)(3) of the FOIA]
financial information [(a)(4) of the PRA]
(b)(4) Release would disclose trade secrets or confidential or financial
P-5 Release would disclose confidential advice between the President
information [(b)(4) of the FOIA]
and his advisors, or between such advisors [a)(5) of the PRA]
(b)(6) Release would constitute a clearly unwarranted invasion of
P-6 Release would constitute a clearly unwarranted invasion of
personal privacy [(b)(6) of the FOIA]
personal privacy [(a)(6) of the PRA]
(b)(7) Release would disclose information compiled for law enforcement
purposes [(b)(7) of the FOIA]
C. Closed in accordance with restrictions contained in donor's deed of
(b)(8) Release would disclose information concerning the regulation of
gift.
financial institutions [(b)(8) of the FOIA]
(b)(9) Release would disclose geological or geophysical information
PRM. Removed as a personal record misfile.
Insert on Health Care Study
Also part of our program for the coming year is a
review of the means by which we may address the quality
and accessibility and cost of our nation's health care
system. The President charged me in his State of the
Union address with leading a review of the recommendations
being made in the several health care studies underway and
recently completed. Several of you are aware of this
activity through your service on the U.S. Bipartisan
Commission on Comprehensive Health Care. This review will
lead to the consideration of options by the President.
Quality, accessibility and cost are not a list of
separate issues. They are one issue. As I conduct this
review I look forward to the cooperation of this Committee
and others who are devoted to improving the health of the
Nation to make the American people aware of the
significance of this issue and their stake in it. For
without the understanding of the American people, progress
will not be possible.