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Coordinated Health Care Event 5/13/92 [OA 6102]
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Coordinated Health Care Event 5/13/92 [OA 6102]
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This is not a textual record. This is used as an
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Speechwriting, White House Office of
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13622-010
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Coordinated Health Care Event 5/13/92 [OA 6102]
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2
2
COORDINATED HEALTH CARE EVENT \ BALTIMORE, MARYLAND
WEDNESDAY, MAY 13, 1992 \ 3:15 P.M.
THANKS, DR. [ROBERT] HEYSSEL [HI-SIL]. I
UNDERSTAND YOU'LL RETIRE IN A FEW WEEKS AS CEO OF JOHNS
HOPKINS HEALTH SYSTEM, AFTER 20 YEARS OF BUILDING
BRIDGES WITH THIS COMMUNITY. You'll LEAVE A GREAT
LEGACY -- THAT NEW OUTPATIENT CLINIC WHICH BEARS YOUR
NAME AND OPENS FOR BUSINESS NEXT MONDAY. WE ALSO HAVE
WITH US TODAY HHS SECRETARY SULLIVAN, CONGRESSMAN
CARDIN, AND GOVERNOR SCHAEFER.
- 2 -
WE ALSO HAVE WITH US TODAY MEMBERS OF THE BALTIMORE
CITY COUNCIL AND THE MARYLAND LEGISLATURE. AND I'M
GLAD TO SEE ROBERT WINTERS, CEO OF THE PRUDENTIAL,
WHO'S MET WITH ME AT THE WHITE HOUSE To DISCUSS THE
FUTURE OF HEALTH CARE.
I'M VERY GLAD To BE HERE AT DUNBAR HIGH, HOME OF
THE DUNBAR POETS. WITH THEIR UNBEATEN STREAK -- MAYBE
PETE POMPEY [POM-PA] SHOULD BECOME MY ADVISOR.
- 3 -
I WAS INTERESTED To HEAR ABOUT YOUR SCHOOL'S
COOPERATIVE HEALTH STUDIES PROGRAM WITH JOHNS HOPKINS
-- WHICH IS NOT ONLY ON A SUMMIT IN BALTIMORE, BUT IS
AT THE SUMMIT OF MEDICAL EXCELLENCE. It's TERRIFIC
THAT NEARLY 20% OF DUNBAR'S STUDENT BODY IS INVOLVED IN
THIS HEALTH STUDIES PROGRAM. I ALSO WANT TO RECOGNIZE
ANOTHER INSTITUTION THAT CALLS DUNBAR HOME --
SOJOURNER-DOUGLASS COLLEGE, FOR ITS STRONG COMMITMENT
TO THE BALTIMORE COMMUNITY.
- 4 -
BEFORE I GO FARTHER, I WANT TO TOUCH ON AN ISSUE
THAT I KNOW INTERESTS EVERYONE CONCERNED ABOUT
CONDITIONS IN AMERICA'S INNER CITIES -- AND ESPECIALLY
IN Los ANGELES. IN ADDITION TO FEMA AND SBA
ASSISTANCE, THE FEDERAL HOME LOAN BANK SYSTEM WILL MAKE
AVAILABLE $600 MILLION DOLLARS -- TO FINANCE THE
REBUILDING OF HOUSING AND BUSINESSES IN Los ANGELES.
- 5 -
THESE LOANS -- MADE THROUGH THE COMMUNITY INVESTMENT
PROGRAMS -- ARE GOOD NEWS FOR THE PEOPLE WHO LOST HOMES
AND JOBS AS WELL AS THE OWNERS WHO LOST BUSINESSES DUE
TO THE UNREST, AND IT'S ONE WAY WE CAN UNDERSCORE THE
FACT THAT WE ARE SERIOUS ABOUT HELPING Los ANGELES
RECOVER.
BEYOND OUR URGENT EMERGENCY AID, WE'VE GOT TO TAKE
ACTION TO BRING HOPE AND OPPORTUNITY TO Los ANGELES --
AND TO ALL AMERICAN CITIES.
- 6 -
YESTERDAY, I CALLED CONGRESSIONAL LEADERS TO THE WHITE
HOUSE -- REPUBLICAN AND DEMOCRAT. I OUTLINED MY 6-
POINT PLAN FOR A NEW AMERICA: OUR WEED AND SEED
ANTI-CRIME INITIATIVE. OUR HOPE HOUSING INITIATIVE.
ENTERPRISE ZONES. EDUCATION REFORM, WELFARE REFORM --
AND A STRONG JOBS PROGRAM FOR CITY YOUTH. I AM PLEASED
WITH THE EARLY REACTION TO MY PLAN. IT'S A PROMISING
START -- AND WE'LL PUSH AHEAD. //
- 7 -
Now, TO THE REASON THAT'S BROUGHT US ALL TOGETHER:
I'VE JUST HAD THE CHANCE TO SPEND SOME TIME FOUR BLOCKS
FROM HERE, IN THE EAST BALTIMORE MEDICAL CENTER -- A
TERRIFIC EXAMPLE THE REST OF THE COUNTRY CAN FOLLOW.
IT'S BASED ON A SPECIAL KIND OF PUBLIC\PRIVATE
PARTNERSHIP -- THE KIND I'VE BEEN ADVOCATING -- IN THIS
CASE AMONG JOHN HOPKINS; THE PRUDENTIAL INSURANCE
COMPANY; THE STATE OF MARYLAND; AND THE FEDERAL
GOVERNMENT.
- 8 -
THIS PROBLEM-SOLVING PARTNERSHIP ADVANCES COORDINATED
CARE -- THE FUTURE OF HEALTH CARE IN THIS COUNTRY. 11
THANKS TO THIS PARTNERSHIP, THIS IS THE LARGEST AND
FASTEST GROWING MEDICAID HMO IN MARYLAND. IT WAS
THERE, EIGHT YEARS AGO, THAT HOPKINS HELPED PIONEER THE
CONCEPT OF A MEDICAID HMO. It's GREAT TO SEE EBMC's
SUCCESS, BECAUSE IT PROVES WHAT I STRONGLY BELIEVE --
THAT WE CAN MEET THE CHALLENGE OF CONTROLLING HEALTH
CARE COSTS WHILE PROVIDING THE FINEST QUALITY SERVICE.
- 9 -
I CONGRATULATE YOU -- FOR WHILE THIS HMO SAVES MEMBERS,
EMPLOYERS AND GOVERNMENT MONEY, HEALTH CARE REMAINS
FIRST-RATE. 11
THE KEY TO THIS CENTER'S SUCCESS, ESPECIALLY FOR
MEDICAID PATIENTS, IS THAT COORDINATED HEALTH CARE
MAKES CREATIVE APPROACHES POSSIBLE. IT PROVIDES
QUALITY CARE AT A LOWER COST, WITH AN EMPHASIS ON
PREVENTION.
- 10 -
It's JUST PLAIN COMMON SENSE -- WE'RE BETTER OFF
KEEPING PEOPLE HEALTHY RATHER THAN TREATING THEM AFTER
THEY'RE SICK. JUST MONDAY, SECRETARY SULLIVAN AND I
MET WITH SOME LEADERS OF OUR EFFORT TO IMPROVE INFANT
HEALTH AND IMMUNIZATION. THERE'S NOTHING THAT MAKES
THE CASE FOR COORDINATED CARE LIKE SEEING HEALTHY KIDS.
PREVENTIVE MEDICINE IMPROVES THE QUALITY OF LIFE FOR
PATIENTS -- AND SAVES UNNECESSARY EXPENDITURES.
- 11 -
COORDINATED CARE CAN WORK FOR ALL AMERICANS. BUT
IT'S ESPECIALLY IMPORTANT FOR MEDICAID RECIPIENTS. IT
ENSURES THEY GET CARE WHEN THEY NEED IT, WHERE THEY
NEED IT, IN A COST-EFFECTIVE WAY. EBMC PROVES THIS IS
A VIABLE ALTERNATIVE TO THE OPPOSITE OF COORDINATED
CARE -- THE FEE-FOR-SERVICE SYSTEM. III
IT ALSO MEANS BETTER CARE FOR A KID WHO STEPS ON A
RUSTY NAIL ON ORLEANS STREET. BEFORE BELONGING TO A
COORDINATED CARE CENTER, HE WOULD HAVE GONE TO HOPKINS'
E.R.
- 12 -
THEY'D BE SEEING HIM FOR THE FIRST TIME, so THEY
WOULDN'T KNOW IF HE'D HAD A TETANUS SHOT, OR IF HE WERE
ALLERGIC TO PENICILLIN. THEY'D HAVE TO SPEND TIME AND
MONEY DOING UNNECESSARY TESTS AND DOUBLE-TREATMENT.
BUT NOW WHEN HE SHOWS UP AT HIS CENTER'S URGENT CARE
UNIT, THEY JUST CHECK HIS HISTORY AND TREAT HIM --
FASTER AND AT A FRACTION OF THE COST. III
- 13 -
I'M EXCITED TO SEE so MANY PIECES OF MY
COMPREHENSIVE HEALTH REFORM PROGRAM ALREADY
SUCCESSFULLY AT WORK AT EBMC. I INTRODUCED THIS PLAN
FEBRUARY 6 TO ADDRESS THE TWIN CHALLENGES OF EXPANDING
ACCESS AND CONTAINING COST -- WHILE BUILDING ON THE
STRENGTHS OF OUR PRESENT HEALTH CARE SYSTEM. I WAS
DETERMINED TO TREAT THE ROOT CAUSES OF OUR PROBLEMS --
NOT JUST THE SYMPTOMS. ABOVE ALL, MY PLAN IS INSPIRED
BY THE WORDS OF PHYSICIAN FREDERICK BANTING: "You MUST
BEGIN WITH AN IDEAL AND END WITH AN IDEAL.' 11
- 14 -
IN THE GREATEST, MOST TECHNOLOGICALLY ADVANCED
NATION ON THE FACE OF THE EARTH, THERE IS NO REASON
THAT ONE OUT OF SEVEN AMERICANS HAS NO HEALTH
INSURANCE. WHAT WE MUST DO IS CLEAR -- WE MUST
GUARANTEE EVERY AMERICAN ACCESS TO AFFORDABLE HEALTH
INSURANCE.
IN THIS ELECTION YEAR, IT SEEMS LIKE EVERYONE'S GOT
THEIR OWN PRESCRIPTION FOR HEALTH CARE. YES, PEOPLE
WANT QUALITY CARE THEY CAN AFFORD AND RELY ON.
- 15 -
BUT WE DON'T NEED TO PUT GOVERNMENT BETWEEN PATIENTS
AND THEIR DOCTORS. WE DON'T NEED TO BUILD A NEW
FEDERAL BUREAUCRACY. WE NEED COMMONSENSE,
COMPREHENSIVE HEALTH CARE REFORM -- AND WE NEED TO
START NOW.
SURE, THE OTHER APPROACHES CAN SOUND GREAT, BUT
WHAT DO YOU REALLY GET? NATIONAL HEALTH INSURANCE
MEANS MORE TAXES, LONG LINES, LONG WAITING LISTS AND
LOWER QUALITY CARE. THEIR IDEA FOR COST CONTROL IS
FLAT OUT "PRICE FIXING" -- AN IDEA WE KNOW WON'T WORK.
- 16 -
Look AT MEDICARE, WHICH ADOPTS SET PRICES FOR MANY
SENIORS' HEALTH SERVICES. BUT MEDICARE INFLATION FAR
OUTSTRIPPED PRIVATE HEALTH CARE INFLATION IN THE 70s
AND 80s AND IS STILL GROWING AT 12% A YEAR. COST
CONTAINMENT IS NOT ITS STRONG SUIT. PRICE FIXING BY
CONGRESS HAS NEVER WORKED BEFORE -- AND IT NEVER WILL.
THE SO-CALLED "PLAY OR PAY" APPROACH IS EQUALLY
UNSOUND. EVEN MANY PROPONENTS ADMIT IT WILL "MELT DOWN"
INTO NATIONAL HEALTH INSURANCE WITHIN A FEW YEARS.
- 17 -
IT DOES NOTHING TO ADDRESS THE COST PROBLEM, WHERE
PATIENTS DON'T KNOW OR CARE HOW MUCH HEALTH CARE
COSTS -- NOTHING, THAT IS, EXCEPT To, ONCE AGAIN, FIX
PRICES. IT's A PACKAGE FULL OF EMPTY PROMISES.
MY COMPREHENSIVE REFORM PLAN IS BASED ON THESE
COMMON SENSE PRINCIPLES: COMPETITION. CONSUMER
CHOICE. QUALITY -- AND EFFICIENCY.
WHILE MOST PEOPLE IN THIS COUNTRY ARE PROVIDED THE
HIGHEST QUALITY HEALTH CARE IN THE WORLD, MILLIONS OF
OTHERS ARE UNINSURED AND MUST BE COVERED.
- 18 -
WE MUST MAKE PEOPLE AWARE OF THE COSTS AND VARYING
QUALITY OF CARE, so THEY'LL BE BETTER CONSUMERS. BUT
THERE WILL ALWAYS BE A LIMIT TO HOW COST-SENSITIVE WE
CAN MAKE PEOPLE. WHEN A KID FALLS OFF A BIKE AND
CRACKS HIS HEAD, NOT MANY PARENTS QUESTION THE COST OF
A CAT SCAN OR AN MRI: THEIR KID'S HEALTH IS TOO
PRECIOUS TO BARGAIN OVER.
So THE COMPETITIVE ANSWER MUST BE TO GROUP OUR
CONSUMERS TOGETHER.
- 19 -
WE MUST COMBINE SMALL EMPLOYERS -- WHO OFTEN PAY THE
BILLS -- AND INDIVIDUALS INTO LARGE, EDUCATED, INFORMED
PURCHASING GROUPS THAT CAN DRIVE EFFICIENCIES BACK INTO
THE HEALTH CARE SYSTEM. THESE HEALTH INSURANCE
NETWORKS WILL POOL CONSUMER INFORMATION, WILL POOL
RISK, AND WILL POOL PURCHASING POWER: TO MAKE THE
SYSTEM MORE RESPONSIVE TO CONSUMER DEMAND. MY PLAN
WILL DRAMATICALLY REFORM OUR MARKET-BASED SYSTEM. IT
WILL ASSURE THAT QUALITY CARE IS WITHIN THE REACH OF
EVERY AMERICAN FAMILY. IT WILL PRESERVE CHOICE.
- 20 -
IT WILL KEEP COSTS DOWN AND ACCESS UP.
FIRST, MY PLAN WILL CUT THE RUNAWAY COSTS OF HEALTH
CARE BY MAKING THE SYSTEM MORE EFFICIENT. WE'LL CALL
FOR INNOVATIVE APPROACHES LIKE THE ONE WE SEE HERE IN
EAST BALTIMORE. SECOND, IT WILL WRING OUT WASTE AND
EXCESS. THIRD, IT WILL CONTROL FEDERAL GROWTH, SINCE
HEALTH CARE IS THE FASTEST GROWING PART OF THE FEDERAL
BUDGET. FOURTH, MY PLAN WILL MAKE HEALTH CARE MORE
ACCESSIBLE BY MAKING IT MORE AFFORDABLE.
- 21 -
WE'LL PROVIDE UP TO $3750 IN HEALTH INSURANCE CREDIT OR
DEDUCTIONS FOR LOW- AND MIDDLE-INCOME FAMILIES AND
GUARANTEE ACCESS TO INSURANCE FOR ALL LOW-INCOME
AMERICANS. THESE CREDITS, COMBINED WITH MARKET
REFORMS, WILL BRING HEALTH INSURANCE TO APPROXIMATELY
30 MILLION UNINSURED AMERICANS.
MARYLAND IS ALREADY GETTING ON BOARD THIS VOUCHER
APPROACH WITH BIPARTISAN LEGISLATION.
- 22 -
THE MARYLAND STATE HOUSE HAS OUTLINED A STANDARD HEALTH
PACKAGE TO COVER ALL LOW-INCOME MARYLANDERS THROUGH TAX
CREDITS. A PROPOSAL To IMPLEMENT THIS TAX CREDIT PLAN
PASSED THE HOUSE A FEW WEEKS AGO AND IS BEING REVIEWED
IN THE LEGISLATURE THIS YEAR. UNDER MY PLAN, THIS TYPE
OF LOW-INCOME CREDIT WOULD BE AVAILABLE IN ALL STATES
-- AND MARYLAND WOULD HAVE THE ABILITY AND FINANCIAL
HELP IT NEEDS TO MAKE THIS REFORM A REALITY.
- 23 -
I'VE PROPOSED THE MOST COMPREHENSIVE HEALTH CARE
PACKAGE ON THE TABLE. Now IS THE TIME TO SEE IF
CONGRESS IS INTERESTED IN REAL REFORM. MINE IS A PLAN
THAT WILL FUNDAMENTALLY RESTRUCTURE HEALTH CARE IN
AMERICA.
THERE ARE STEPS WE CAN AND MUST TAKE RIGHT NOW.
PART OF MY PLAN ENTAILS SIGNIFICANT REFORM OF THE
INSURANCE MARKETS, FOR WHICH THERE IS STRONG BIPARTISAN
SUPPORT.
- 24 -
SENATOR BENTSEN, CHAIRMAN ROSTENKOWSKI, SENATE
REPUBLICANS AND THE HOUSE REPUBLICAN TASK FORCE ALL
SUPPORT VERY SIMILAR REFORMS THAT -- WITH SOME
MODIFICATION -- CAN, AND SHOULD, BE PASSED IMMEDIATELY.
CONGRESS MUST BEGIN TO MOVE NOW. EVEN IF ALL THEY DO
THIS YEAR IS JUST PASS MY INSURANCE MARKET REFORM --
WE'LL AT LEAST GET A START ON CHANGING THE SYSTEM.
THESE REFORMS WILL GO A LONG WAY TOWARD CURING THE
INEQUITIES IN COST AND COVERAGE UNDER EXISTING HEALTH
INSURANCE PRACTICES.
- 25 -
AND THERE'S ANOTHER BIPARTISAN REFORM PACKAGE,
PROPOSED BY SENATORS DURENBERGER AND MOYNIHAN, THAT IS
IN MOST RESPECTS CONSISTENT WITH MY PLAN AND WOULD
PROMOTE MUCH GREATER USE OF COORDINATED CARE IN
MEDICAID. EAST BALTIMORE KNOWS THIS WORKS. WE MUST
MAKE IT EASIER FOR THE REST OF THE COUNTRY To FOLLOW
YOUR ROAD TO BETTER HEALTH CARE. IN FACT, AS PART OF MY
PLAN FOR COMPREHENSIVE REFORM, I WANT To MAKE
COORDINATED CARE THE NORM, NOT THE EXCEPTION, FOR
MEDICAID.
- 26 -
WE MUST WORK TOGETHER NOW TO PASS THESE REFORMS THAT
WILL PROVIDE MILLIONS OF AMERICANS WITH AFFORDABLE
HEALTH COVERAGE: AND GET A LEG UP ON COMPREHENSIVE
REFORM.
OUR PLAN DOES EVERYTHING THE GOVERNMENT CAN AND
SHOULD DO TO ENSURE THE QUALITY OF LIFE OF EACH CITIZEN
OF THIS GREAT LAND. IT DOESN'T PROMISE THE MOON. IT
DOES SOMETHING MORE IMPORTANT: IT PROMISES THE FUTURE.
REFORM IS NEVER EASY, BUT IN HEALTH CARE IT'S A MUST.
- 27 -
WE'LL DELIVER WHAT WE SAY WE CAN -- COMPETITION-
DRIVEN, MARKET-BASED REFORM -- AND WE'LL DELIVER IT
PROUDLY. I'LL CONTINUE TO PUSH FOR IT. WE MUST GET
STARTED TODAY.
THANK YOU FOR ALL YOU DO -- AND FOR THE BRILLIANT
EXAMPLE EBMC PROVIDES FOR THIS NATION. MAY GOD BLESS
YOU ALL.
# # # #
Document No. 327243ss
WHITE HOUSE STAFFING MEMORANDUM
DATE:
5/11/92
ACTION/CONCURRENCE/COMMENT DUE BY: NOON TUES., MAY 12
PRESIDENTIAL REMARKS: COORDINATED HEALTH CARE EVENT
SUBJECT:
WEDNESDAY, MAY 13, 1992
BALTIMORE, MARYLAND
ACTION FYI
ACTION FYI
VICE PRESIDENT
HORNER
SKINNER
MCBRIDE
SCOWCROFT
MOORE
X
additional add
wide
DARMAN N/C
PETERSMEYER
BRADY
PORTER
BROMLEY
ROGICH
CALIO
N/C
ROLLINS N/C
DEMAREST
SMITH N/C
YEUTTER
FITZWATER
GRAY Renquist 2898 N/C
FINDLAY
HOLIDAY
KAUFMAN
MCGROARTY
REMARKS:
Please forward your comments directly to Dan McGroarty, rm
122, ext. 2930, NO LATER THAN NOON TUESDAY, MAY 12, with a
copy to this office.
Thank you.
RESPONSE:
Dumbar acknowledsemat
CALL + WARN
AT 10tol030
PHILLIP D. BRADY
sistant to the President
and Staff Secretary
Ext. 2702
(Hinchliffe/Gershowitz)
May 11, 1992 12 p.m.
BALTIMORE Draft One
MAY P2: 16
PRESIDENTIAL REMARKS:
COORDINATED HEALTH CARE EVENT
WEDNESDAY MAY 13, 1992
BALTIMORE, MARYLAND
[ACKNOWLEDGEMENTS] I've just had the chance to spend some
time four blocks from here, in the East Baltimore Medical Center.
Most impressive -- a terrific example the rest of the country can
follow. It's based on a special kind of public/private partner-
ship -- the kind I've been advocating -- in this case among Johns
Hopkins; The Prudential, a private insurance company; the state
of Maryland; and the federal government. This problem-solving
partnership heralds the future of health care in this country.
Thanks to this partnership, EBMC is the largest and fastest
growing Medicaid HMO in Maryland. It was there, eight years ago,
that Hopkins developed the concept of a Medicaid HMO. It's great
to see EBMC's success, because it proves what I strongly believe:
that health care and insurance industries can meet the challenge
of controlling health care costs while providing the finest
quality service. I congratulate you -- for while this HMO saves
mem-bers, employers and government money, health care remains
first-rate.
The key to EBMC's success, especially for Medicaid patients,
is that coordinated health care makes creative approaches
possible. It provides coordinated, quality care at a lower cost,
while emphasizing prevention and extra benefits, like EBMC's free
dental work and great pre-natal care in the Better Beginnings
Program. It's just plain commonsense -- we're better off keeping
2
people healthy rather than treating them after they're sick.
Preventive medicine improves the quality of life for patients --
and saves the health care system unnecessary expenditures.
Coordinated care works for all Americans, because it changes
the incentives. It's especially important for Medicaid recipi-
ents because of the difficulties they face in receiving care. It
helps ensure they're given care when they need it, where they
need it, and in a cost-effective way. EBMC proves that this kind
of care is a viable alternative to the fee-for-service system.
I'm excited to see so many pieces of my Comprehensive Health
Reform Program already successfully at work at EBMC. I introduced
this plan February 6, to address the twin challenges of expanding
access and containing cost -- while building on the strengths of
our present health care system. I was determined to treat the
root causes of our problems -- not just the symptoms. I think
the medical professionals here can understand that. Above all,
my plan is inspired by the words of British doctor Sir Frederick
Banting: "You must begin with an ideal and end with an ideal."
I'm appalled to think that in the greatest, most technologi-
cally advanced nation on the face of the earth, one out of seven
Americans has no health insurance. That is a disgrace and we
must not tolerate it. What we must do is clear -- We must
guarantee every American access to affordable health insurance.
In this election year, it seems like everyone's got their
own prescription for health care. Yes, people want quality care
they can afford and rely on. But we don't need to put government
3
between patients and their doctors. We don't need to build a new
federal bureaucracy. We need commonsense, comprehensive health
care reform -- and we need it now.
Sure, the other approaches can sound great, but what do you
really get? National Health Insurance means long lines, long
waiting lists and lower quality care. The idea for cost control
is flat out "price fixing" -- an idea we know won't work. Some
point to Canada: what they don't know, or just don't say, is
that Canada's health inflation now outpaces ours. Others point
to Medicare, which adopts set prices for many seniors' health
services. But Medicare inflation far outstripped private health
care inflation in the 70s and 80s and is still growing at 12% a
year. Cost containment is not its strong suit. Price fixing by
Congress has never worked before -- and it never will.
The so-called Play or Pay approach is equally unsound. Even
many proponents admit it will "melt down" into National Health
Insurance within a few years. And it does nothing to address the
underlying flaws of the health care system or change the dynamics
of the way health care is delivered -- except to, once again, fix
prices. It's a package full of empty promises. For those of us
who still think capitalism is a good idea; for those of us who
think markets and competition are what this country is built on
and stands for; for those of us who think competition breeds
quality and efficiency: I proposed my Comprehensive Reform Plan.
True, the health market hasn't always worked well. Most
people are insured, and therefore insulated against the
4
skyrocketing costs of health care. Millions of others are
uninsured and must be covered. But we haven't done anything to
reform private health care since WWII. We must make people more
aware of the costs and varying quality of care, so that they'll
be better consumers.
But there will always be a limit to how cost-sensitive we
can make individuals. When a kid falls off a bike and cracks his
head, not many parents question the cost of a CAT scan or an MRI
before given: their kid's health is too precious to bargain over.
So the competitive answer must be to group our consumers
together. We must combine employers, who often pay the bills,
and individuals into large, educated, informed purchasing groups
that can drive efficiencies back into the health care system.
These purchasing groups, or Health Insurance Networks, will pool
this information, will pool risk, and will pool consumer purchas-
ing power: to make the system more responsive to consumer demand.
My plan will dramatically reform our market-based system. It
will put quality care within the reach of every American family.
It will preserve choice. It will keep costs down and access up.
Part one of my plan says we'll cut the runaway costs of
health care by making the system more efficient. We'll call for
innovative approaches -- like the one we see right here in East
Baltimore. Part two of my plan says we'll wring out waste and
excess by reforming the system. Part three says we'll control
federal growth: since health care is the fastest growing part of
the federal budget.
5
And part four of my plan says we'll make health care more
accessible by making it more affordable. We'll provide up to
$3750 in health insurance credit or deductions for low- and
middle-income families and guarantee access to all low-income
Americans. These credits, combined with market reforms, will
bring health insurance to almost 30 million uninsured Americans.
Maryland is already getting on board this voucher approach
with bipartisan legislation. State Rep. Casper Taylor, with the
support of Blue Cross/Blue Shield of Maryland, outlined a $3600
standard health package to cover all low-income Marylanders
through tax credits. The Maryland "Consumer Choice" plan passed
the Maryland House a few weeks ago 134-0. This is the type of
state reform my plan encourages: under it, Maryland would have
much of the flexibility needed to make this reform a reality.
Since we unveiled our reforms three months ago, we've moved
ahead with our proposals, following through step by step on
everything we outlined in that historic plan. What's most
important is that we've put together a health care legislative
package -- and we can start to move now.
And now is the time to see if Congress is really interested
in passing useful legislation. We've submitted a great plan. It
will lift the hearts and ease the pain of literally millions of
Americans who today are sick and scared. Congress must move now.
Even if differences in Congress prevent passing my compre-
hensive package this partisan election year, there are steps we
must take. Part of my plan entails significant reform of the
6
insurance markets, for which there is strong bipartisan support.
Senator Bentsen and Chairman Rostenkowski have proposed very
similar reforms that can, and should, be passed immediately.
These reforms will go a long way toward curing the inequities in
cost and coverage under existing health insurance practices.
And there's another bipartisan reform package, proposed by
5.2077
Senators Durenberger and Moynihan, that's consistent with my plan
and would promote much greater use of coordinated care in
Medicaid. As those at EMBC know -- this works. We must make it
easier for the rest of the country to follow your road to better
health care. We must work together now to pass these reforms
that will provide millions of Americans with affordable health
coverage -- and get a leg up on comprehensive reform.
Our plan does everything the government can and should do to
ensure the quality of life of each citizen of this great land.
It doesn't promise the moon -- it does something more important.
It promises the future. Reform is never easy, but in health care
it's a must. We'll deliver what we say we can -- competition-
driven, market-based reform -- and we'll deliver it proudly. I
will continue to push for it. We must get started today.
Thank you for all you do -- and for the brilliant example
EBMC provides for this nation. May God bless you all.
#
#
#
#
THE WHITE HOUSE
WASHINGTON
May 13, 1992
MEMORANDUM FOR DAVE DEMAREST
FROM:
CLAYTON YEUTTER
4
SUBJECT:
East Baltimore Medical Center Speech
We have had some feedback from Congressional Republicans
that we have not been sufficiently supportive of their health
care legislative efforts.
On page 6 of the remarks, as forwarded to the President,
there is a reference to "Senator Bentsen and Chairman
Rostenkowski have proposed That should become "Senator
Bentsen, Chairman Rostenkowski, Senate Republicans, and the
House Republican task all support
Also, the whole
paragraph is out of order with the last sentence of the
previous paragraph, a sentence about insurance reform. See the
attached mark up for a smoother approach.
Thanks for your help on this.
CC: Phil Brady
force
6
would have the ability and financial help it needs to make this
reform a reality.
I've proposed the most comprehensive health care package on
the table. Now is the time to see if Congress is interested in
real reform. Mine is a plan that will fundamentally restructure
health care in America.
Congress must begin to move now. Even
market
if all they do this year is just pass my insurance proposal
reform -- we'll at least get a start on changing the system.
There are other steps we can and must take right now. Part
of my plan entails significant reform of the insurance markets,
for which there is strong bipartisan support. Senator Bentsen
and Chairman Rostenkowski have proposed very similar reforms that
-- with some modification -- can, and should, be passed
immediately.
These reforms will go a long way toward curing the
inequities in cost and coverage under existing health insurance
practices.
And there's another bipartisan reform package, proposed by
Senators Durenberger and Moynihan, that is in most respects con-
sistent with my plan and would promote much greater use of coor-
dinated care in Medicaid. East Baltimore knows this works. We
must make it easier for the rest of the country to follow your
road to better health care. In fact, as part of my plan for com-
prehensive reform, I want to make coordinated care the norm, not
the exception, for Medicaid. We must work together now to pass
these reforms that will provide millions of Americans with affor-
dable health coverage: and get a leg up on comprehensive reform.
THE WHITE HOUSE
WASHINGTON
May 12, 1992
MEMORANDUM FOR THE PRESIDENT
of
THROUGH:
DAVID DEMAREST
FROM:
BETH HINCHLIFFE
BH
SUBJECT:
EAST BALTIMORE MEDICAL CENTER SPEECH
On Wednesday, May 13, you will speak at Dunbar High School
in Baltimore. You will have just completed a tour of the East
Baltimore Medical Center (EBMC), a coordinated health care center
that enrolls Medicaid recipients. The audience, approximately
850, will consist primarily of local small business owners who
subscribe to the center, and health care professionals and
faculty from Johns Hopkins.
The address concentrates on the medical center, which
embodies many of the ideas of your comprehensive health reform
proposal. Your remarks (12 minutes, cards) focus on your plan
and how EBMC's coordinated care reflects the core of your ideas.
They compare your plan to others, and end by calling on Congress
for action. Explanations: the Dunbar Poets are the school's
basketball team, and Pete Pompey is their coach.
(Hinchliffe/Gershowitz)
May 12, 1992 4 p.m.
BALTIMORE Draft Four
PRESIDENTIAL REMARKS: COORDINATED HEALTH CARE EVENT
WEDNESDAY MAY 13, 1992
BALTIMORE, MARYLAND
[ACKNOWLEDGEMENTS]
[[ Before I go farther, I want to touch on an issue that I
know interests everyone concerned about conditions in America's
inner cities -- and especially in Los Angeles. The Federal
Housing Finance Board will make available $600 million dollars -
- to finance the rebuilding of housing and businesses in Los
Angeles. These loans -- made through the Community Investment
Program -- are good news for the people who lost jobs and the
owners who lost businesses due to the unrest, and it's one way we
can underscore the fact that we are serious about helping Los
Angeles recover. ]]
Now, to the reason that's brought us all together: I've
just had the chance to spend some time four blocks from here, in
the East Baltimore Medical Center -- a terrific example the rest
of the country can follow. It's based on a special kind of
public/private partnership -- the kind I've been advocating -- in
this case among Johns Hopkins; The Prudential insurance company;
the state of Maryland; and the federal government. This problem-
solving partnership advances coordinated care -- the future of
health care in this country. 11
Thanks to this partnership, this is the largest and fastest
growing Medicaid HMO in Maryland. It was there, eight years ago,
that Hopkins helped pioneer the concept of a Medicaid HMO. It's
2
great to see EBMC's success, because it proves what I strongly
believe -- that we can meet the challenge of controlling health
care costs while providing the finest quality service. I
congratulate you -- for while this HMO saves members, employers
and government money, health care remains first-rate.
The key to this center's success, especially for Medicaid
patients, is that coordinated health care makes creative
approaches possible. It provides quality care at a lower cost,
with an emphasis on prevention.
It's just plain common sense -- we're better off keeping
people healthy rather than treating them after they're sick.
Just Monday, Secretary Sullivan and I met with some leaders of
our effort to improve infant health and immunization. There's
nothing that makes the case for coordinated care like seeing
healthy kids. Preventive medicine improves the quality of life
for patients -- and saves unnecessary expenditures.
Coordinated care can work for all Americans. But it's espe-
cially important for Medicaid recipients. It ensures they get
care when they need it, where they need it, in a cost-effective
way. EBMC proves this is a viable alternative to the opposite of
coordinated care -- the fee-for-service system. 111
It also means better care for a kid who steps on a rusty nail
on Orleans Street. Before belong to a coordinated care center,
he would have gone to Hopkins' E.R. They'd be seeing him for the
first time, so they wouldn't know if he'd had a tetanus shot, or
if he were allergic to penicillin. They'd have to spend time and
3
money doing unnecessary tests and double-treatment. But now when
he shows up at his center's Urgent Care Unit, they just check his
history and treat him -- faster and at a fraction of the cost.\\\
I'm excited to see so many pieces of my Comprehensive Health
Reform Program already successfully at work at EBMC. I introduced
this plan February 6 to address the twin challenges of expanding
access and containing cost -- while building on the strengths of
our present health care system. I was determined to treat the
root causes of our problems -- not just the symptoms. Above all,
my plan is inspired by the words of physician Frederick Banting:
"You must begin with an ideal and end with an ideal. 11
In the greatest, most technologically advanced nation on the
face of the earth, there is no reason that one out of seven
Americans has no health insurance. What we must do is clear --
We must guarantee every American access to affordable health
insurance. 11
In this election year, it seems like everyone's got their
own prescription for health care. Yes, people want quality care
they can afford and rely on. But we don't need to put government
between patients and their doctors. We don't need to build a new
federal bureaucracy. We need commonsense, comprehensive health
care reform -- and we need to start now.
Sure, the other approaches can sound great, but what do you
really get? National health insurance means more taxes, long
lines, long waiting lists and lower quality care. Their idea for
cost control is flat out "price fixing" -- an idea we know won't
4
work. Look at Medicare, which adopts set prices for many seniors'
health services. But Medicare inflation far outstripped private
health care inflation in the 70s and 80s and is still growing at
12% a year. Cost containment is not its strong suit. Price
fixing by Congress has never worked before -- and it never will.
The so-called "play or pay" approach is equally unsound. Even
many proponents admit it will "melt down" into national health
insurance within a few years. It does nothing to address the
cost problem, where patients don't know or care how much health
care costs -- nothing, that is, except to, once again, fix
prices. It's a package full of empty promises.
For those of us who still think capitalism is a good idea;
for those of us who think markets and competition are what this
country is built on and stands for; for those of us who value
consumer choice; for those of us who think competition breeds
quality and efficiency: I proposed my Comprehensive Reform Plan.
While most people in this country are provided the highest
quality health care in the world, millions of others are
uninsured and must be covered. We must make people aware of the
costs and varying quality of care, so they'll be better
consumers. But there will always be a limit to how cost-
sensitive we can make people. When a kid falls off a bike and
cracks his head, not many parents question the cost of a CAT scan
or an MRI: their kid's health is too precious to bargain over.
so the competitive answer must be to group our consumers
together. We must combine small employers, who often pay the
5
bills, and individuals into large, educated, informed purchasing
groups that can drive efficiencies back into the health care
system. These Health Insurance Networks will pool consumer
information, will pool risk, and will pool purchasing power: to
make the system more responsive to consumer demand. My plan will
dramatically reform our market-based system. It will assure that
quality care is within the reach of every American family. It
will preserve choice. It will keep costs down and access up.
First, my plan will cut the runaway costs of health care by
making the system more efficient. We'll call for innovative
approaches like the one we see here in East Baltimore. Second,
it will wring out waste and excess. Third, it will control fed-
eral growth, since health care is the fastest growing part of the
federal budget. Fourth, my plan will make health care more acces-
sible by making it more affordable. We'll provide up to $3750 in
health insurance credit or deductions for low- and middle-income
families and guarantee access to insurance for all low-income Am-
ericans. These credits, combined with market reforms, will bring
health insurance to approximately 30 million uninsured Americans.
Maryland is already getting on board this voucher approach
with bipartisan legislation. The Maryland State House, with the
support of Blue Cross/Blue Shield of Maryland, outlined a $3600
standard health package to cover all low-income Marylanders
through tax credits. The Maryland "Consumer Choice" plan passed
the House a few weeks ago 134-0. This type of low-income credit
would be available in all states under my plan, and Maryland
6
would have the ability and financial help it needs to make this
reform a reality.
I've proposed the most comprehensive health care package on
the table. Now is the time to see if Congress is interested in
real reform. Mine is a plan that will fundamentally restructure
health care in America. Congress must begin to move now. Even
if all they do this year is just pass my insurance proposal
reform -- we'll at least get a start on changing the system.
There are other steps we can and must take right now. Part
of my plan entails significant reform of the insurance markets,
for which there is strong bipartisan support. Senator Bentsen
and Chairman Rostenkowski have proposed very similar reforms that
-- with some modification -- can, and should, be passed
immediately. These reforms will go a long way toward curing the
inequities in cost and coverage under existing health insurance
practices.
And there's another bipartisan reform package, proposed by
Senators Durenberger and Moynihan, that is in most respects con-
sistent with my plan and would promote much greater use of coor-
dinated care in Medicaid. East Baltimore knows this works. We
must make it easier for the rest of the country to follow your
road to better health care. In fact, as part of my plan for com-
prehensive reform, I want to make coordinated care the norm, not
the exception, for Medicaid. We must work together now to pass
these reforms that will provide millions of Americans with affor-
dable health coverage: and get a leg up on comprehensive reform.
7
Our plan does everything the government can and should do to
ensure the quality of life of each citizen of this great land.
It doesn't promise the moon. It does something more important:
it promises the future. Reform is never easy, but in health care
it's a must. We'll deliver what we say we can -- competition-
driven, market-based reform -- and we'll deliver it proudly.
I'll continue to push for it. We must get started today.
Thank you for all you do -- and for the brilliant example
EBMC provides for this nation. May God bless you all.
#
#
#
#
THE WHITE HOUSE
WASHINGTON
May 12, 1992
MEMORANDUM FOR THE PRESIDENT
of
THROUGH:
DAVID DEMAREST
FROM:
BETH HINCHLIFFE
BH
SUBJECT:
EAST BALTIMORE MEDICAL CENTER SPEECH
On Wednesday, May 13, you will speak at Dunbar High School
in Baltimore. You will have just completed a tour of the East
Baltimore Medical Center (EBMC), a coordinated health care center
that enrolls Medicaid recipients. The audience, approximately
850, will consist primarily of local small business owners who
subscribe to the center, and health care professionals and
faculty from Johns Hopkins.
The address concentrates on the medical center, which
embodies many of the ideas of your comprehensive health reform
proposal. Your remarks (12 minutes, cards) focus on your plan
and how EBMC's coordinated care reflects the core of your ideas.
They compare your plan to others, and end by calling on Congress
for action. Explanations: the Dunbar Poets are the school's
basketball team, and Pete Pompey is their coach.
(Hinchliffe/Gershowitz)
May 12, 1992 4 p.m.
BALTIMORE Draft Four
PRESIDENTIAL REMARKS:
COORDINATED HEALTH CARE EVENT
WEDNESDAY MAY 13, 1992
BALTIMORE, MARYLAND
[ACKNOWLEDGEMENTS]
[[ Before I go farther, I want to touch on an issue that I
know interests everyone concerned about conditions in America's
inner cities -- and especially in Los Angeles. The Federal
Housing Finance Board will make available $600 million dollars -
- to finance the rebuilding of housing and businesses in Los
Angeles. These loans -- made through the Community Investment
Program -- are good news for the people who lost jobs and the
owners who lost businesses due to the unrest, and it's one way we
can underscore the fact that we are serious about helping Los
Angeles recover. ]]
Now, to the reason that's brought us all together: I've
just had the chance to spend some time four blocks from here, in
the East Baltimore Medical Center -- a terrific example the rest
of the country can follow. It's based on a special kind of
public/private partnership -- the kind I've been advocating -- in
this case among Johns Hopkins; The Prudential insurance company;
the state of Maryland; and the federal government. This problem-
solving partnership advances coordinated care -- the future of
health care in this country. 11
Thanks to this partnership, this is the largest and fastest
growing Medicaid HMO in Maryland. It was there, eight years ago,
that Hopkins helped pioneer the concept of a Medicaid HMO. It's
2
great to see EBMC's success, because it proves what I strongly
believe -- that we can meet the challenge of controlling health
care costs while providing the finest quality service. I
congratulate you -- for while this HMO saves members, employers
and government money, health care remains first-rate. 11
The key to this center's success, especially for Medicaid
patients, is that coordinated health care makes creative
approaches possible. It provides quality care at a lower cost,
with an emphasis on prevention.
It's just plain common sense -- we're better off keeping
people healthy rather than treating them after they're sick.
Just Monday, Secretary Sullivan and I met with some leaders of
our effort to improve infant health and immunization. There's
nothing that makes the case for coordinated care like seeing
healthy kids. Preventive medicine improves the quality of life
for patients -- and saves unnecessary expenditures.
Coordinated care can work for all Americans. But it's espe-
cially important for Medicaid recipients. It ensures they get
care when they need it, where they need it, in a cost-effective
way. EBMC proves this is a viable alternative to the opposite of
coordinated care -- the fee-for-service system. 111
It also means better care for a kid who steps on a rusty nail
on Orleans Street. Before belong to a coordinated care center,
he would have gone to Hopkins' E.R. They'd be seeing him for the
first time, so they wouldn't know if he'd had a tetanus shot, or
if he were allergic to penicillin. They'd have to spend time and
3
money doing unnecessary tests and double-treatment. But now when
he shows up at his center's Urgent Care Unit, they just check his
history and treat him -- faster and at a fraction of the cost. III
I'm excited to see so many pieces of my Comprehensive Health
Reform Program already successfully at work at EBMC. I introduced
this plan February 6 to address the twin challenges of expanding
access and containing cost -- while building on the strengths of
our present health care system. I was determined to treat the
root causes of our problems -- not just the symptoms. Above all,
my plan is inspired by the words of physician Frederick Banting:
"You must begin with an ideal and end with an ideal. " 11
In the greatest, most technologically advanced nation on the
face of the earth, there is no reason that one out of seven
Americans has no health insurance. What we must do is clear --
We must guarantee every American access to affordable health
insurance.
In this election year, it seems like everyone's got their
own prescription for health care. Yes, people want quality care
they can afford and rely on. But we don't need to put government
between patients and their doctors. We don't need to build a new
federal bureaucracy. We need commonsense, comprehensive health
care reform -- and we need to start now.
Sure, the other approaches can sound great, but what do you
really get? National health insurance means more taxes, long
lines, long waiting lists and lower quality care. Their idea for
cost control is flat out "price fixing" -- an idea we know won't
4
work. Look at Medicare, which adopts set prices for many seniors'
health services. But Medicare inflation far outstripped private
health care inflation in the 70s and 80s and is still growing at
12% a year. Cost containment is not its strong suit. Price
fixing by Congress has never worked before -- and it never will.
The so-called "play or pay" approach is equally unsound. Even
many proponents admit it will "melt down" into national health
insurance within a few years. It does nothing to address the
cost problem, where patients don't know or care how much health
care costs -- nothing, that is, except to, once again, fix
prices. It's a package full of empty promises.
For those of us who still think capitalism is a good idea;
for those of us who think markets and competition are what this
country is built on and stands for; for those of us who value
consumer choice; for those of us who think competition breeds
quality and efficiency: I proposed my Comprehensive Reform Plan.
While most people in this country are provided the highest
quality health care in the world, millions of others are
uninsured and must be covered. We must make people aware of the
costs and varying quality of care, so they'll be better
consumers. But there will always be a limit to how cost-
sensitive we can make people. When a kid falls off a bike and
cracks his head, not many parents question the cost of a CAT scan
or an MRI: their kid's health is too precious to bargain over.
so the competitive answer must be to group our consumers
together. We must combine small employers, who often pay the
5
bills, and individuals into large, educated, informed purchasing
groups that can drive efficiencies back into the health care
system. These Health Insurance Networks will pool consumer
information, will pool risk, and will pool purchasing power: to
make the system more responsive to consumer demand. My plan will
dramatically reform our market-based system. It will assure that
quality care is within the reach of every American family. It
will preserve choice. It will keep costs down and access up.
First, my plan will cut the runaway costs of health care by
making the system more efficient. We'll call for innovative
approaches like the one we see here in East Baltimore. Second,
it will wring out waste and excess. Third, it will control fed-
eral growth, since health care is the fastest growing part of the
federal budget. Fourth, my plan will make health care more acces-
sible by making it more affordable. We'll provide up to $3750 in
health insurance credit or deductions for low- and middle-income
families and guarantee access to insurance for all low-income Am-
ericans. These credits, combined with market reforms, will bring
health insurance to approximately 30 million uninsured Americans.
Maryland is already getting on board this voucher approach
with bipartisan legislation. The Maryland State House, with the
support of Blue Cross/Blue Shield of Maryland, outlined a $3600
standard health package to cover all low-income Marylanders
through tax credits. The Maryland "Consumer Choice" plan passed
the House a few weeks ago 134-0. This type of low-income credit
would be available in all states under my plan, and Maryland
6
would have the ability and financial help it needs to make this
reform a reality.
I've proposed the most comprehensive health care package on
the table. Now is the time to see if Congress is interested in
real reform. Mine is a plan that will fundamentally restructure
health care in America. Congress must begin to move now. Even
if all they do this year is just pass my insurance proposal
reform -- we'll at least get a start on changing the system.
There are other steps we can and must take right now. Part
of my plan entails significant reform of the insurance markets,
for which there is strong bipartisan support. Senator Bentsen
and Chairman Rostenkowski have proposed very similar reforms that
-- with some modification -- can, and should, be passed
immediately. These reforms will go a long way toward curing the
inequities in cost and coverage under existing health insurance
practices.
And there's another bipartisan reform package, proposed by
Senators Durenberger and Moynihan, that is in most respects con-
sistent with my plan and would promote much greater use of coor-
dinated care in Medicaid. East Baltimore knows this works. We
must make it easier for the rest of the country to follow your
road to better health care. In fact, as part of my plan for com-
prehensive reform, I want to make coordinated care the norm, not
the exception, for Medicaid. We must work together now to pass
these reforms that will provide millions of Americans with affor-
dable health coverage: and get a leg up on comprehensive reform.
7
Our plan does everything the government can and should do to
ensure the quality of life of each citizen of this great land.
It doesn't promise the moon. It does something more important:
it promises the future. Reform is never easy, but in health care
it's a must. We'll deliver what we say we can -- competition-
driven, market-based reform -- and we'll deliver it proudly.
I'll continue to push for it. We must get started today.
Thank you for all you do -- and for the brilliant example
EBMC provides for this nation. May God bless you all.
#
#
#
#
May 12, 1992
MEMORANDUM FOR THE PRESIDENT
THROUGH:
DAVID DEMAREST
FROM:
BETH HINCHLIFFE
SUBJECT:
EAST BALTIMORE MEDICAL CENTER SPEECH
On Wednesday, May 13, at XX p.m., you will speak at Dunbar
High School in Baltimore. You will have just completed a tour of
the East Baltimore Medical Center (EBMC), a coordinated health
care center that enrolls Medicaid recipients. The audience,
approximately 850, will consist primarily of local small business
owners who subscribe to the center, and health care professionals
and faculty from Johns Hopkins.
The address concentrates on the medical center, which
embodies many of the ideas of your comprehensive health reform
proposal. Your remarks (12 minutes, cards) focus on your plan
and how EBMC's coordinated care reflects the core of your ideas.
They compare your plan to others, and end by calling on Congress
for action.
(Hinchliffe/Gershowitz)
May 12, 1992 4 p.m.
BALTIMORE Draft Four
PRESIDENTIAL REMARKS: COORDINATED HEALTH CARE EVENT
WEDNESDAY MAY 13, 1992
BALTIMORE, MARYLAND
[ACKNOWLEDGEMENTS]
[[ Before I go farther, I want to touch on an issue that I
know interests everyone concerned about conditions in America's
inner cities -- and especially in Los Angeles. The Federal
Housing Finance Board will make available $600 million dollars -
- to finance the rebuilding of housing and businesses in Los
adulistin
Angeles. These loans -- made through the Community Investment
in
IGA
A
Program -- are good news for the people who lost jobs and the
owners who lost businesses due to the unrest, and it's one way we
can underscore the fact that we are serious about helping Los
Angeles recover. ]]
Now, to the reason that's brought us all together: I've
just had the chance to spend some time four blocks from here, in
the East Baltimore Medical Center -- a terrific example the rest
of the country can follow. It's based on a special kind of
public/private partnership -- the kind I've been advocating -- in
this case among Johns Hopkins; The Prudential insurance company;
the state of Maryland; and the federal government. This problem-
solving partnership advances coordinated care -- the future of
health care in this country.
Thanks to this partnership, this is the largest and fastest
growing Medicaid HMO in Maryland. It was there, eight years ago,
that Hopkins helped pioneer the concept of a Medicaid HMO. It's
2
great to see EBMC's success, because it proves what I strongly
believe -- that we can meet the challenge of controlling health
care costs while providing the finest quality service. I
congratulate you -- for while this HMO saves members, employers
and government money, health care remains first-rate. 11
The key to this center's success, especially for Medicaid
patients, is that coordinated health care makes creative
approaches possible. It provides quality care at a lower cost,
with an emphasis on prevention.
It's just plain common sense -- we're better off keeping
people healthy rather than treating them after they're sick.
Just Monday, Secretary Sullivan and I met with some leaders of
our effort to improve infant health and immunization. There's
nothing that makes the case for coordinated care like seeing
healthy kids. Preventive medicine improves the quality of life
for patients -- and saves unnecessary expenditures.
Coordinated care can work for all Americans. But it's espe-
cially important for Medicaid recipients. It ensures they get
care when they need it, where they need it, in a cost-effective
way. EBMC proves this is a viable alternative to the opposite of
coordinated care -- the fee-for-service system. III
It also means better care for a kid who steps on a rusty nail
on Orleans Street. Before belong to a coordinated care center,
he would have gone to Hopkins E.R. They'd be seeing him for the
first time, so they wouldn't know if he'd had a tetanus shot, or
if he were allergic to penicillin. They'd have to spend time and
3
money doing unnecessary tests and double-treatment. But now when
he shows up at his center's Urgent Care Unit, they just check his
history and treat him -- faster and at a fraction of the cost.
I'm excited to see so many pieces of my Comprehensive Health
Reform Program already successfully at work at EBMC. I introduced
this plan February 6 to address the twin challenges of expanding
access and containing cost -- while building on the strengths of
our present health care system. I was determined to treat the
root causes of our problems -- not just the symptoms. Above all,
my plan is inspired by the words of physician Frederick Banting:
"You must begin with an ideal and end with an ideal. "
In the greatest, most technologically advanced nation on the
face of the earth, there is no reason that one out of seven
Americans has no health insurance. What we must do is clear --
We must guarantee every American access to affordable health
insurance. 11
In this election year, it seems like everyone's got their
own prescription for health care. Yes, people want quality care
they can afford and rely on. But we don't need to put government
between patients and their doctors. We don't need to build a new
federal bureaucracy. We need commonsense, comprehensive health
care reform -- and we need to start now.
Sure, the other approaches can sound great, but what do you
really get? National health insurance means more taxes, long
lines, long waiting lists and lower quality care. Their idea for
cost control is flat out "price fixing" -- an idea we know won't
4
work. Look at Medicare, which adopts set prices for many seniors'
health services. But Medicare inflation far outstripped private
health care inflation in the 70s and 80s and is still growing at
12% a year. Cost containment is not its strong suit. Price
fixing by Congress has never worked before -- and it never will.
The so-called "play or pay" approach is equally unsound. Even
many proponents admit it will "melt down" into national health
insurance within a few years. It does nothing to address the
cost problem, where patients don't know or care how much health
care costs -- nothing, that is, except to, once again, fix
prices. It's a package full of empty promises.
My, proposal
is based
For those of us who still think capitalism is a good idea
on
for those of us who think markets and competition are what this
little
country is built on and stands for; for those of us who value
consumer choice; for those of us who think competition breeds
quality and efficiency: I proposed my Comprehensive Reform Plan
While most people in this country are provided the highest
quality health care in the world, millions of others are
uninsured and must be covered. We must make people aware of the
costs and varying quality of care, so they'll be better
consumers. But there will always be a limit to how cost-
sensitive we can make people. When a kid falls off a bike and
cracks his head, not many parents question the cost of a CAT scan
or an MRI: their kid's health is too precious to bargain over.
So the competitive answer must be to group our consumers
together. We must combine small employers, who often pay the
5
bills and individuals, into large, educated, informed purchasing
groups that can drive efficiencies back into the health care
system. These Health Insurance Networks will pool consumer
information, will pool risk, and will pool purchasing power: to
make the system more responsive to consumer demand. My plan will
dramatically reform our market-based system. It will assure that
quality care is within the reach of every American family. It
will preserve choice. It will keep costs down and access up.
First, my plan will cut the runaway costs of health care by
making the system more efficient. We'll call for innovative
approaches like the one we see here in East Baltimore. Second,
it will wring out waste and excess. Third, it will control fed-
eral growth, since health care is the fastest growing part of the
federal budget. Fourth, my plan will make health care more acces-
sible by making it more affordable. We'll provide up to $3750 in
health insurance credit or deductions for low- and middle-income
families and guarantee access to insurance for all low-income Am-
ericans. These credits, combined with market reforms, will bring
health insurance to approximately 30 million uninsured Americans.
Maryland is already getting on board this voucher approach
with bipartisan legislation. The Maryland State House, with the
support of Blue Cross/Blue Shield of Maryland, outlined a $3600
standard health package to cover all low-income Marylanders
through tax credits. The Maryland "Consumer Choice" plan passed
the House a few weeks ago 134-0. This type of low-income credit
would be available in all states under my plan, and Maryland
not
allowable now
6
would have the ability and financial help it needs to make this
reform a reality.
I've proposed the most comprehensive health care package on
the table. Now is the time to see if Congress is interested in
real reform. Mine is a plan that will fundamentally restructure
health care in America. Congress must begin to move now. Even
if all they do this year is just pass my insurance proposal
reform -- we'll at least get a start on changing the system.
There are other steps we can and must take right now. Part
of my plan entails significant reform of the insurance markets,
for which there is strong bipartisan support. Senator Bentsen
and Chairman Rostenkowski have proposed very similar reforms that
-- with some modification -- can, and should, be passed
immediately. These reforms will go a long way toward curing the
inequities in cost and coverage under existing health insurance
practices.
And there's another bipartisan reform package, proposed by
Senators Durenberger and Moynihan, that is in most respects con-
sistent with my plan and would promote much greater use of coor-
dinated care in Medicaid. East Baltimore knows this works. We
must make it easier for the rest of the country to follow your
road to better health care. In fact, as part of my plan for com-
prehensive reform, I want to make coordinated care the norm, not
the exception, for Medicaid. We must work together now to pass
these reforms that will provide millions of Americans with affor-
dable health coverage: and get a leg up on comprehensive reform.
7
Our plan does everything the government can and should do to
ensure the quality of life of each citizen of this great land.
It doesn't promise the moon. It does something more important:
it promises the future. Reform is never easy, but in health care
it's a must. We'll deliver what we say we can -- competition-
driven, market-based reform -- and we'll deliver it proudly.
I'll continue to push for it. We must get started today.
Thank you for all you do -- and for the brilliant example
EBMC provides for this nation. May God bless you all.
#
#
#
#
SENT BY:Xerox Telecopier 7020 ; 5-12-92 ; 2:49PM ;
OPD-
2024566218:# 1
Document No. 327243ss
WHITE HOUSE STAFFING MEMORANDUM
92 MAY 12 P3: 52
DATE:
5/11/92
ACTION/CONCURRENCE/COMMENT DUE BY: NOON TUES., MAY 12
PRESIDENTIAL REMARKS: COORDINATED HEALTH CARE EVENT
SUBJECT:
WEDNESDAY, MAY 13, 1992
BALTIMORE, MARYLAND
ACTION FYI
ACTION FYI
VICE PRESIDENT
HORNER
SKINNER
MCBRIDE
SCOWCROFT
MOORE
DARMAN
PETERSMEYER
BRADY
PORTER
BROMLEY
ROGICH
CALIO
ROLLINS
DEMAREST
SMITH
YEUTTER
FITZWATER
GRAY
FINDLAY
HOLIDAY
KAUFMAN
MCGROARTY
REMARKS:
Please forward your comments directly to Dan McGroarty, rm
122, ext. 2930, NO LATER THAN NOON TUESDAY, MAY 12, with a
copy to this office.
Thank you.
RESPONSE:
See comments. PK Thanks. (HHS comments).
Paul KorEonta
05/12
PHILLIP D. BRADY
Assistant to the President
and Staff Secretary
Ext. 2702
THE WHITE HOUSE
WASHINGTON
60 :hd 60:rd 26
May 12, 1992
MEMORANDUM FOR DANIEL B. McGROARTY
Special Assistant to the President and
Deputy Director of Speechwriting
FROM:
JANET REHNQUIST JR
Associate Counsel to the President
SUBJECT:
Presidential Remarks --- Coordinated Health Care
Event; Wednesday, May 13, 1992; Baltimore,
Maryland
At your request, Counsel's Office has reviewed the above-
referenced matter. We have no legal objections.
Thank you for the opportunity to review this matter.
CC: Phil Brady
Border them. Hames K.
(Hinchliffe/Gershowitz)
May 12, 1992 2 p.m.
BALTIMORE Draft Three
PRESIDENTIAL REMARKS: COORDINATED HEALTH CARE EVENT
WEDNESDAY MAY 13, 1992
BALTIMORE, MARYLAND
[ACKNOWLEDGEMENTS] I've just had the chance to spend some
time four blocks from here, in the East Baltimore Medical Center
-- a terrific example the rest of the country can follow. It's
based on a special kind of public/private partnership -- the kind
I've been advocating -- in this case among Johns Hopkins; The
Prudential insurance company; the state of Maryland; and the
federal government. This problem-solving partnership advances
coordinated care -- the future of health care in this country.
Thanks to this partnership, this is the largest and fastest
growing HMO serving Medicaid recipients in Maryland. It was
there, eight years ago, that Hopkins established its HMO to serve
Medicaid recipients; now it enrolls working Americans as well.
EMBO'S
It's great to see this success, because it proves what I strongly
believe -- that we can meet the challenge of controlling health
care costs while providing the finest quality service. I
congratulate you -- for while this HMO saves members, employers
and government money, health care remains first-rate.
The key to this center's success, especially for Medicaid
patients, is that coordinated health care makes creative
approaches possible. It provides quality care in a way that
assures that patients get the care they need -- not too much and
X
not too little -- at a lower cost. It also emphasizes prevention
and extra benefits. Anyone can come to East Baltimore and see
2
how this key idea is working -- in programs I just visited today
like nutrition classes; pediatric clinics; and the pre-natal care
of the Better Beginnings Program. I heard how pregnant women in
[PROJECT] will have healthier babies, needing less after-birth
care, because they're followed and educated and tested and
encouraged by care and incentives each step of the way.
It's just plain common sense -- we're better off keeping
people healthy rather than treating them after they're sick.
Just Monday, Secretary Sullivan and I met with some leaders of
our effort to improve infant health and immunization. There's
nothing that makes the case for coordinated care like seeing
healthy kids. Preventive medicine improves the quality of life
for patients -- and saves unnecessary expenditures.
Coordinated care can work for all Americans. It's espe-
cially important for Medicaid recipients. It ensures they
get
yes
care when they need it, where they need it, in a cost-effective
way. EBMC proves this is a viable alternative to the opposite of
X
coordinated care: the a la carte fee-for-service system.
And it also means better care for a kid who steps on a rusty
nail on Orleans Street. Before belong to a coordinated care
center, he would have gone to Hopkins' Emergency Room. They'd be
seeing him for the first time, so they wouldn't have known if
he'd had a tetanus shot -- or if he were allergic to penicillin -
- they'd have to spend time and money doing unnecessary tests and
double-treatment. But now, when he shows up at his center's
Urgent Care Unit, they just check his history and treat him --
3
faster and at a fraction of the cost.
This center isn't unique. There are exciting examples of
NO
how coordinated care can provide better, less expensive care for
Medicaid recipients all across the country -- like ACCESS in
detail
is
Arizona; Comprehensive Health Systems in Detroit; and Health
five.
Partners in Philadelphia. These centers demonstrate the core
but
will
Gowl
idea of my Comprehensive Health Reform Program. I introduced
cut
this plan February 6 to address the twin challenges of expanding
Staffed pdra-
for space
access and containing cost -- while building on the strengths of
our present health care system. I was determined to treat the
delete fro
root causes of our problems -- not just the symptoms.
Above all,
staffed
my plan is inspired by the words of physician Frederick Banting:
draft,
"You must begin with an ideal and end with an ideal."
I'm appalled to think that in the greatest, most technologi-
cally advanced nation on the face of the earth, one out of seven
Americans has no health insurance. That is a disgrace and we
must not tolerate it. What we must do is clear -- We must
guarantee every American access to affordable health insurance.
In this election year, it seems like everyone's got their
own prescription for health care. Yes, people want quality care
they can afford and rely on. But we don't need to put government
between patients and their doctors. We don't need to build a new
federal bureaucracy. We need commonsense, comprehensive health
care reform -- and we need to start now.
Sure, the other approaches can sound great, but what do you
really get? National Health Insurance means more taxes, long
4
lines, long waiting lists and lower quality care. Their idea for
cost control is flat out "price fixing" -- an idea we know won't
work. Some point to Canada: what they don't know, or just don't
keep
7
say, is that Canada's health inflation now outpaces ours. Others
Looh at
point to Medicare, which adopts set prices for many seniors'
health services. But Medicare inflation far outstripped private
health care inflation in the 70s and 80s and is still growing at
12% a year. Cost containment is not its strong suit. Price
fixing by Congress has never worked before -- and it never will.
The so-called Play or Pay approach is equally unsound. Even
many proponents admit it will "melt down" into national health
insurance within a few years. And it does nothing to address the
cost problem, where patients don't know or care how much health
care costs --- except to, once again, fix prices. It's a package
full of empty promises. For those of us who still think
capitalism is a good idea; for those of us who think markets and
competition are what this country is built on and stands for; for
those of us who think competition breeds quality and efficiency:
I proposed my Comprehensive Reform Plan.
It's different from all these other plans in one critically
essential way. Their attitude is: we'll junk the system and
start over from scratch. Not only is that unnecessary -- it's
fundamentally wrong. There's too much that's good about our
health care system -- too many accomplishments in which we take
great pride. We have the best health care in the world -- we
just need to make sure it's available to everyone. We want to do
5
something new for that one out of seven who doesn't have access
now: other plans want to do something new for seven out of seven.
9
Our health care system hasn't always worked well. Most
people are insured and therefore insulated against the skyrocket-
ing costs of health care. Millions of others are uninsured and
must be covered. But we haven't done anything to reform private
health care since WWII. We must make people aware of the costs
and varying quality of care, so they'll be better consumers. But
there will always be a limit to how cost-sensitive we can make
people. When a kid falls off a bike and cracks his head, not
many parents question the cost of a CAT [cat] scan or an MRI
before given: their kid's health is too precious to bargain over.
So the competitive answer must be to group our consumers
together. We must combine small employers, who often pay the
bills, and individuals into large, educated, informed purchasing
groups that can drive efficiencies back into the health care
system. These Health Insurance Networks will pool consumer
information, will pool risk, and will pool purchasing power: to
make the system more responsive to consumer demand. My plan will
dramatically reform our market-based system. It will assure that
quality care is within the reach of every American family. It
will preserve choice. It will keep costs down and access up.
Part one of my plan says we'll cut the runaway costs of
health care by making the system more efficient. We'll call for
innovative approaches like the one we see here in East Baltimore.
Part two of my plan says we'll wring out waste and excess.
6
Part three says we'll control federal growth -- since health care
is the fastest growing part of the federal budget.
And part four of my plan says we'll make health care more
accessible by making it more affordable. We'll provide up to
$3750 in health insurance credit or deductions for low- and
middle-income families and guarantee access to all low-income
Americans. These credits, combined with market reforms, will
bring health insurance to almost 30 million uninsured Americans.
Maryland is already getting on board this voucher approach
with bipartisan legislation. The Maryland State House, with the
support of Blue Cross/Blue Shield of Maryland, outlined a $3600
standard health package to cover all low-income Marylanders
through tax credits. The Maryland "Consumer Choice" plan passed
the Maryland House a few weeks ago 134-0. This type of low-
income credit would be available in all states under my plan, and
Maryland would have the ability to make this reform a reality B
replaceds
I've proposed the most comprehensive health care package on
the table. Now is the time to see if Congress is interested in
real reform. Mine is a plan that will fundamentally restructure
health care in America. Congress must begin to move now. Even
if all they do this year is just pass my insurance proposal
reform -- we'll at least get a start on changing the system.
Even Xf differences in Congress prevent passing my compre-
hensive package this partisan election year, there are steps we
can and must take. Part of my plan entails significant reform of
the insurance markets, for which there is strong bipartisan
7
support. Senator Bentsen and Chairman Rostenkowski have proposed
very similar reforms that can, and should, be passed immediately.
These reforms will go a long way toward curing the inequities in
cost and coverage under existing health insurance practices.
And there's another bipartisan reform package, proposed by
Senators Durenberger and Moynihan, that's consistent with my plan
and would promote much greater use of coordinated care in Medic-
aid. As those at East Baltimore know: this works. We must make
it easier for the rest of the country to follow your road to
better health care. In fact, as part of my plan for comprehensive
reform, I want to make coordinated care the norm, rather than the
exception, for Medicaid. We must work together now to pass these
reforms that will provide millions of Americans with affordable
health coverage -- and get a leg up on comprehensive reform.
Our plan does everything the government can and should do to
ensure the quality of life of each citizen of this great land.
It doesn't promise the moon -- it does something more important.
It promises the future. Reform is never easy, but in health care
it's a must. We'll deliver what we say we can -- competition-
driven, market-based reform -- and we'll deliver it proudly. I
will continue to push for it. We must get started today.
Thank you for all you do -- and for the brilliant example
EBMC provides for this nation. May God bless you all.
#
#
#
#
Document No. 327243ss
WHITE HOUSE STAFFING MEMORANDUM
DATE:
5/11/92
ACTION/CONCURRENCE/COMMENT DUE BY: NOON TUES., MAY 12
PRESIDENTIAL REMARKS: COORDINATED HEALTH CARE EVENT
SUBJECT:
WEDNESDAY, MAY 13, 1992
BALTIMORE, MARYLAND
ACTION FYI
ACTION FYI
VICE PRESIDENT
HORNER
SKINNER
MCBRIDE
SCOWCROFT
MOORE
DARMAN
PETERSMEYER
BRADY
PORTER
BROMLEY
ROGICH
CALIO
ROLLINS
DEMAREST
SMITH
YEUTTER
FITZWATER
GRAY
FINDLAY
HOLIDAY
KAUFMAN
MCGROARTY
REMARKS:
Please forward your comments directly to Dan McGroarty, rm
122, ext. 2930, NO LATER THAN NOON TUESDAY, MAY 12, with a
copy to this office.
Thank you,
RESPONSE:
See Comments
Please take commuts lay
PHILLIP D. BRADY
Assistant to the President
and Staff Secretary
Ext. 2702
(Hinchliffe/Gershowitz)
May 11, 1992 12 p.m.
BALTIMORE Draft One
MAY P2: 16
PRESIDENTIAL REMARKS: COORDINATED HEALTH CARE EVENT
WEDNESDAY MAY 13, 1992
BALTIMORE, MARYLAND
[ACKNOWLEDGEMENTS] I've just had the chance to spend some
time four blocks from here, in the East Baltimore Medical Center.
Most impressive -- a terrific example the rest of the country can
follow. It's based on a special kind of public/private partner-
ship -- the kind I've been advocating -- in this case among Johns
Hopkins; The Prudential, a private insurance company; the state
of Maryland; and the federal government. This problem-solving
partnership heralds the future of health care in this country.
Thanks to this partnership, EBMC is the largest and fastest
growing Medicaid HMO in Maryland. It was there, eight years ago,
helped pioneer
that Hopkins developed the concept of a Medicaid HMO. It's great Senlly 5178
to see EBMC's success, because it proves what I strongly believe:
that health care and insurance industries can meet the challenge
of controlling health care costs while providing the finest
quality service. I congratulate you -- for while this HMO saves
mem-bers, employers and government money, health care remains Seally
5178
first-rate.
The key to EBMC's success, especially for Medicaid patients,
is that coordinated health care makes creative approaches
possible. It provides coordinated, quality care at a lower cost,
while emphasizing prevention and extra benefits, like EBMC's free
Services
dental work and great pre-natal care in the Better Beginnings SCULLY
5178
Program. It's just plain commonsense -- we're better off keeping
2
people healthy rather than treating them after they're sick.
Preventive medicine improves the quality of life for patients --
and saves the health care system unnecessary expenditures.
Coordinated care works for all Americans, because it changes
the incentives. It's especially important for Medicaid recipi-
ents because of the difficulties they face in receiving care. It
helps ensure they're given care when they need it, where they
need it, and in a cost-effective way. EBMC proves that this kind
of care is a viable alternative to the fee-for-service system.
I'm excited to see so many pieces of my Comprehensive Health
Reform Program already successfully at work at EBMC. I introduced
this plan February 6, to address the twin challenges of expanding
access and containing cost -- while building on the strengths of
our present health care system. I was determined to treat the
root causes of our problems -- not just the symptoms. I think
the medical professionals here can understand that. Above all,
my plan is inspired by the words of British doctor Sir Frederick
Banting: "You must begin with an ideal and end with an ideal."
I'm appalled to think that in the greatest, most technologi-
cally advanced nation on the face of the earth, one out of seven
Americans has no health insurance. That is a disgrace and we
must not tolerate it. What we must do is clear -- We must
guarantee every American access to affordable health insurance.
In this election year, it seems like everyone's got their
own prescription for health care. Yes, people want quality care
they can afford and rely on. But we don't need to put government
3
between patients and their doctors. We don't need to build a new
federal bureaucracy. We need commonsense, comprehensive health
care reform -- and we need it now.
Sure, the other approaches can sound great, but what do you
h
really get? National Health Insurance means long lines, long SCULLY 5178
waiting lists and lower quality care. The idea for cost control
is flat out "price fixing" -- an idea we know won't work. Some
point to Canada: what they don't know, or just don't say, is
that Canada's health inflation now outpaces ours. Others point
to Medicare, which adopts set prices for many seniors' health
services. But Medicare inflation far outstripped private health
care inflation in the 70s and 80s and is still growing at 12% a
year. Cost containment is not its strong suit. Price fixing by
Congress has never worked before -- and it never will.
"P
P
P "
The so-called lay or Pay approach is equally unsound. Even
many proponents admit it will "melt down" into National Health h
Seully
5178
Insurance within a few years. And it does nothing to address the
underlying flaws of the health care system or change the dynamics
of the way health care is delivered -- except to, once again, fix
prices. It's a package full of empty promises. For those of us
who still think capitalism is a good idea; for those of us who
eses
think markets and competition are what this country is built on
for those of us who value consumer choice SCULLY
and stands for; ^ for those of us who think competition breeds 5178
quality and efficiency: I proposed my Comprehensive Reform Plan.
True, the health market hasn't always worked well. Most
people are insured, and therefore insulated against the
4
skyrocketing costs of health care. Millions of others are
uninsured and must be covered. But we haven't done anything to
reform private health care since WWII. We must make people more
aware of the costs and varying quality of care, so that they'll
be better consumers.
But there will always be a limit to how cost-sensitive we
can make individuals. When a kid falls off a bike and cracks his
head, not many parents question the cost of a CAT scan or an MRI
before given: their kid's health is too precious to bargain over.
So the competitive answer must be to group our consumers
together. We must combine employers, who often pay the bills,
and individuals into large, educated, informed purchasing groups
that can drive efficiencies back into the health care system.
These purchasing groups, or Health Insurance Networks, will pool
this information, will pool risk, and will pool consumer purchas- SEULLY
Consumer's' interest 5178
ing power: to make the system more responsive to consumer demand.
My plan will dramatically reform our market-based system. It
will put quality care within the reach of every American family.
It will preserve choice. It will keep costs down and access up.
FORST,
What
Part one of my plan says we'll cut the runaway costs of
are
health care by making the system more efficient. We'll call for
these
part
innovative Second approaches -- like the one we see right here in East
of?
Baltimore.
excess by reforming the system. Part This three says we'll control
Part two of my plan says we'll wring out waste and
Senily
5178
federal growth: since health care is the fastest growing part of
the federal budget.
5
And part four of my plan says we'll make health care more
accessible by making it more affordable. We'll provide up to
$3750 in health insurance credit or deductions for low- and
insurance for Sennly
middle-income families and guarantee access to all low-income 5178
Americans. These credits, combined with market reforms, will
Oya
bring health insurance to almost 30 million uninsured Americans. SCULLY 5128
approximately
Maryland is already getting on board this voucher approach
with bipartisan legislation. State Rep. Casper Taylor, with the
support of Blue Cross/Blue Shield of Maryland, outlined a $3600
standard health package to cover all low-income Marylanders
through tax credits. The Maryland "Consumer Choice" plan passed
the Maryland House a few weeks ago 134-0. This is the type of
state reform my plan encourages: under it, Maryland would have
much of the flexibility needed to make this reform a reality.
Since we unveiled our reforms three months ago, we've moved
ahead with our proposals, following through step by step on
everything we outlined in that historic plan. What's most
important is that we've put together a health care legislative
package -- and we can start to move now.
And now is the time to see if Congress is really interested
in passing useful legislation. We've submitted a great plan. It
will lift the hearts and ease the pain of literally millions of
Americans who today are sick and scared. Congress must move now.
Even if differences in Congress prevent passing my compre-
hensive package this partisan election year, there are steps we
must take. Part of my plan entails significant reform of the
with some modification - -
6
insurance markets, for which there is strong bipartisan support.
Senator Bentsen and Chairman Rostenkowski have proposed very
SCULLY
along with modifications that I have proposed
5178
similar reforms that can, and should, be passed immediately.
These reforms will go a long way toward curing the inequities in
cost and coverage under existing health insurance practices.
Disin is in
And there's another bipartisan reform package, proposed by
Senators Durenberger and Moynihan, that's 2 consistent with my plan SCULLY 5178
mostly
respect) and would promote much greater use of coordinated care in
Most
Medicaid. As those at EMBC know -- this works. We must make it
easier for the rest of the country to follow your road to better
health care. We must work together now to pass these reforms
that will provide millions of Americans with affordable health
coverage -- and get a leg up on comprehensive reform.
Our plan does everything the government can and should do to
ensure the quality of life of each citizen of this great land.
It doesn't promise the moon -- it does something more important.
It promises the future. Reform is never easy, but in health care
consumer and
it's a must. We'll deliver what we say we can ^ competition- SCULLY 5178
driven, market-based reform -- and we'll deliver it proudly. I
will continue to push for it. We must get started today.
Thank you for all you do -- and for the brilliant example
EBMC provides for this nation. May God bless you all.
#
#
#
#
SENT BY:Xerox Telecopier 7020 ; 5-12-92 ; 2:50PM ;
OPD->
2024566218;# 2
MAY-12-1992 02:45 FROM DEP SEC HHS
TO
4562223 P.02
(Hinchliffe/Cershewits)
May 11, 1992 12 p.m.
BALTIMORE Draft One
MAY P2: 16
PRESIDENTIAL REMARKS: COORDINATED HEALTH CARE EVENT
WEDNESDAY MAY 23, 1992
BALTINORE, MARYLAND
[ACKNOWLEDGEMENTS] I've just had the chance to spand some
time four blocks from here, in the East Baltimore Medical Center.
Most impressive -- a terrific example the rest of the country can
follow. It's based on a special kind of public/private partner-
ship -- the kind I've been advocating -- in this case among Johns
Hopkins; The Prudential, private Ansurance delete sempany; the state
of Maryland; and the federal government. This problem-solving
partnership heralds the future of health care in this country.
IS POTUS to say this?
Thanks to this partnership, EBMC is the largest and fastest
delets
4.
growing Medicaid HMO in Maryland. It was there, eight years ago,
a
for their
that Hopkins developed the concept of e Medicaid HMO. It's great
to *** EBMC's success, because it proves what I strongly believe:
that health care and insurance industries can meet the challenge
of controlling health care costs while providing the finest
plan
quality service. I congratulate you -- for while this - saves
members, employers and government money, health care remains
first-rate.
The key to FBMC's success, especially for Medicaid patients,
is that coordinated health sare makes creative approaches
possible. It provides coordinated, quality care at & lower cost,
while emphasizing prevention and extra benefits, like EEMC's free
dental work and great pre-natel care in the Better Beginnings
Program. It's just plain commonsense ⑉ we're better off keeping
SENT BY:Xerox Telecopier 7020 ; 5-12-92 ; 2:50PM ;
OPD->
2024566218:# 3
MAY-12-1992 02:45 FROM DEP SEC HHS
TO
4562223 F.03
a
people healthy rather than treating them after they're sick.
Preventive medicine improves the quality of life for patients --
and saves the health care system unnecessary expenditures.
Coordinated care works for all Americans, because it changes
the incentives. It's especially important for Medicaid recipi-
ents because of the difficulties they face in receiving care. It
helps ensure they're given care when they need it, where they
to
à
need it, and in a cost-effective way. HEMO prover that this kind
of care is a viable alternative to the fas-for-service system.
I'm excited to ⑉ so many pieces of my comprehensive Health
Reform Program already successfully at work at EBMC. I introduced
this plan February 6, to address the twin challenges of expanding
assess and containing cost -- while building on the strengths of
our present health care system. I was determined to treat the
root causes of our problems -- not just the symptoms. I think
the medical professionals here can understand that. Above all,
my plan is inspired by the words of British doctor Sir Frederick
Banting: "You must begin with an ideal and end with an ideal."
Gos
appelled to In the greatost, most technologi-
there is no reason that
cally advanced nation on the face of the earth, one out of seven
Americans has no health insurance.
delite
What we must de is clear -- We must
guarantee every American access to affordable health insurance.
In this election year, it seems like everyone's got their
own prescription for health care. Yes, people want quality care
they can afford and rely on. But yes don't used to put government
SENT BY:Xerox Telecopier 7020 ; 5-12-92 ; 2:51PM ;
OPD-
2024566218;# 4
MAY-12-1992 02:46 FROM DEP SEC HHS
TO
4562223 P.04
3
between patients and their doctors. We don't need to build a new
federal bureaucracy. We need commonsense, comprehensive health
care reform -- and we need it now.
Sure, the other approaches can sound great, but what do you
really get? National Health Insurance means long lines, long
waiting lists and lower quality are. The idea for cost control
is flat out "price fixing" -- an idea we know won't work.
Some
point to Canada: what they don't know, or just don't say, is
that Ganada's health inflation now outpaces ours. others point
delate.
to Medicare, which adopts set prices for many seniors' health
services. But Medicare inflation far outstripped private health
wo
care inflation in the 70s and 80m and is still growing at 12% a
year Cost containment is not its strong suit.
Frice fixing by
Congress has never worked before -- and it never will.
The sc-called Play or Pay approach is equally unsound. Even
many prepenents admit it will "melt down" into National Health
Insurance within & few years. And it does nothing to address the
underlying flaws of the health care system or change the dynamics
of the way health care is delivered encept to, once again, fix
N//
prices. It's a package full of empty promises. For those of as
who still capitalism is good ideas for those of us who
think markets and competition are what this country is built on
and stands for; for those of us who think competition breeds
quality and efficiency: I proposed my Comprehensive Reform Plan.
True, the health market heen't stways worked well. Most
people are insured, and therefore insulated against the
SENT BY:Xerox Telecopier 7020 ; 5-12-92 ; 2:51PM ;
OPD->
2024566218:# 5
MAY-12-1992 02:47 FROM DEP SEC HHS
TO
4562223 P.05
While the country are
most people in this
provided the 4 highest Quality health care
Ana
in the worky
Millions of others are
uninsured and must be covered. But we haven't done anything be
reform prévate henlth care since wwrr. We must make people more
aware of the costs and varying quality of care, so that they'll
be better consumers.
But there will always be a limit to how cost-sensitive we
can make individuals. When a kid falls off a bike and cracks his
head, not many parents question the cost of a CAT scan or an MRI:
before given: their kid's health is too precious to bargain over.
so the competitive answer must be to group our consumers
together. We must combine employers, who often pay the bills,
and individuals into large, educated, informed purchasing groups
that can drive efficiencies back into the health care system.
These purchasing groups, or Health Insurance Networks, will pool
this information, will pool risk, and will pool consumer purchas-
ing power: to make the system more responsive to consumer demand.
My plan will dramatically reform our market-based system. It
will put quality care within the reach of every American family.
It will preserve choice. It will keep costs down and access up.
Part one of my plan says we'll out the runaway costs of
health care by making the system nore efficient. We'll call for
innovative approaches -- like the one we see right here in East
waste and
No
Baltimore. Part two of my plan says we'll wring out
secree by reforming the system. Part three says we'll
restrain
No
federal growth: since health care is the fastest growing part of
the federal budget.
SENT BY:Xerox Telecopier 7020 ; 5-12-92 ; 2:52PM ;
OPD->
2024566218:# 6
MAY-12-1992 02:47 FROM DEP SEC HHS
TO
4562223 P.06
5
And part four of my plan says we'll make health care more
accessible by making it neve affordable. We'll provide up to
$3750 in health insurance credit or deductions for low- and
middle-income families and guarantee access to all low-income
Americans. These credits, combined with market reforms, will
bring health insurance to almost 30 million uninsured Americans.
Maryland is already getting on board this voucher approach
with bipartisan legislation. State Rep. Casper Taylor, with the
support of Blue Cross/Blue Shield of Maryland, outlined a $3600
NO
standard health package to cover all low income Marylanders
through tax credits. -The Maryland "Consumer Choice" plan passed
the Maryland House a few weeks ago 134-0. This is the type of
my plan,
state reform my plan encourages: under LA, Maryland would have
and financial helpit
much of the flexibility needed to make this reform a reality.
since we unveiled our reforms three months ago, we've moved
shead with our proposals, following through step by step on
everything we outlined in that OUR historic plan. What's most
important is that we've put together a health care legislative
package -- and we can start to move now.
And now is the time to see if Congress is really interested
in passing useful legislation. We've submitted & detailed quest plan. It
will lift the hearts and case the pain of literally millions of
Americans who today are siok and scared. Congress must move now.
Even if differences in Congress prevent passing my compre-
hensive package this partisan election year, there are steps we
must take. Part of my plan entails significant reform of the
(Hinchliffe/Gershowitz)
May 12, 1992 3 p.m.
BALTIMORE Draft Four
PRESIDENTIAL REMARKS:
COORDINATED HEALTH CARE EVENT
WEDNESDAY MAY 13, 1992
BALTIMORE, MARYLAND
[ACKNOWLEDGEMENTS] I've just had the chance to spend some
time four blocks from here, in the East Baltimore Medical Center
-- a terrific example the rest of the country can follow. It's
based on a special kind of public/private partnership -- the kind
I've been advocating -- in this case among Johns Hopkins; The
Prudential insurance company; the state of Maryland; and the
federal government. This problem-solving partnership advances
coordinated care -- the future of health care in this country. 11
Thanks to this partnership, this is the largest and fastest
growing Medicaid HMO in Maryland. It was there, eight years ago,
that Hopkins helped pioneer the concept of a Medicaid HMO. It's
great to see EBMC's success, because it proves what I strongly
believe -- that we can meet the challenge of controlling health
care costs while providing the finest quality service. I
congratulate you -- for while this HMO saves members, employers
and government money, health care remains first-rate. 11
The key to this center's success, especially for Medicaid
patients, is that coordinated health care makes creative
approaches possible. It provides quality care at a lower cost,
while emphasizing prevention and extra benefits.
It's just plain common sense -- we're better off keeping
people healthy rather than treating them after they're sick.
Just Monday, Secretary Sullivan and I met with some leaders of
2
our effort to improve infant health and immunization. There's
nothing that makes the case for coordinated care like seeing
healthy kids. Preventive medicine improves the quality of life
for patients -- and saves unnecessary expenditures.
Coordinated care can work for all Americans. But it's espe-
cially important for Medicaid recipients. It ensures they get
care when they need it, where they need it, in a cost-effective
way. EBMC proves this is a viable alternative to the opposite of
coordinated care -- the fee-for-service system. III
It also means better care for a kid who steps on a rusty nail
on Orleans Street. Before belong to a coordinated care center,
he would have gone to Hopkins' E.R. They'd be seeing him for the
first time, so they wouldn't know if he'd had a tetanus shot, or
if he were allergic to penicillin. They'd have to spend time and
money doing unnecessary tests and double-treatment. But now when
he shows up at his center's Urgent Care Unit, they just check his
history and treat him -- faster and at a fraction of the cost. III
I'm excited to see so many pieces of my Comprehensive Health
Reform Program already successfully at work at EBMC. I introduced
this plan February 6 to address the twin challenges of expanding
access and containing cost -- while building on the strengths of
our present health care system. I was determined to treat the
root causes of our problems -- not just the symptoms. Above all,
my plan is inspired by the words of physician Frederick Banting:
"You must begin with an ideal and end with an ideal. " 11
I'm appalled to think that in the greatest, most technologi-
3
cally advanced nation on the face of the earth, one out of seven
Americans has no health insurance. That is a disgrace and we
must not tolerate it. What we must do is clear -- We must
guarantee every American access to affordable health insurance.
In this election year, it seems like everyone's got their
own prescription for health care. Yes, people want quality care
they can afford and rely on. But we don't need to put government
between patients and their doctors. We don't need to build a new
federal bureaucracy. We need commonsense, comprehensive health
care reform -- and we need to start now.
Sure, the other approaches can sound great, but what do you
really get? National health insurance means more taxes, long
lines, long waiting lists and lower quality care. Their idea for
cost control is flat out "price fixing" -- an idea we know won't
work. Look at Medicare, which adopts set prices for many seniors'
health services. But Medicare inflation far outstripped private
health care inflation in the 70s and 80s and is still growing at
12% a year. Cost containment is not its strong suit. Price
fixing by Congress has never worked before -- and it never will.
The so-called "play or pay" approach is equally unsound. Even
many proponents admit it will "melt down" into national health
insurance within a few years. It does nothing to address the
cost problem, where patients don't know or care how much health
care costs -- nothing, that is, except to, once again, fix
prices. It's a package full of empty promises.
For those of us who still think capitalism is a good idea;
4
for those of us who think markets and competition are what this
country is built on and stands for; for those of us who value
consumer choice; for those of us who think competition breeds
quality and efficiency: I proposed my Comprehensive Reform Plan.
Our health care system hasn't always worked well. Most
people are insured and therefore insulated against the skyrocket-
ing costs of health care. Millions of others are uninsured and
must be covered. But we haven't done anything to reform private
health care since WWII. We must make people aware of the costs
and varying quality of care, so they'll be better consumers. But
there will always be a limit to how cost-sensitive we can make
people. When a kid falls off a bike and cracks his head, not
many parents question the cost of a CAT [cat] scan or an MRI
before given: their kid's health is too precious to bargain over.
So the competitive answer must be to group our consumers
together. We must combine small employers, who often pay the
bills, and individuals into large, educated, informed purchasing
groups that can drive efficiencies back into the health care
system. These Health Insurance Networks will pool consumer
information, will pool risk, and will pool purchasing power: to
make the system more responsive to consumer demand. My plan will
dramatically reform our market-based system. It will assure that
quality care is within the reach of every American family. It
will preserve choice. It will keep costs down and access up.
First, my plan will cut the runaway costs of health care by
making the system more efficient. We'll call for innovative
5
approaches like the one we see here in East Baltimore. Second,
it will wring out waste and excess. Third, it will control fed-
eral growth, since health care is the fastest growing part of the
federal budget. Fourth, my plan will make health care more acces-
sible by making it more affordable. We'll provide up to $3750 in
health insurance credit or deductions for low- and middle-income
families and guarantee access to insurance for all low-income Am-
ericans. These credits, combined with market reforms, will bring
health insurance to approximately 30 million uninsured Americans.
Maryland is already getting on board this voucher approach
with bipartisan legislation. The Maryland State House, with the
support of Blue Cross/Blue Shield of Maryland, outlined a $3600
standard health package to cover all low-income Marylanders
through tax credits. The Maryland "Consumer Choice" plan passed
the House a few weeks ago 134-0. This type of low-income credit
would be available in all states under my plan, and Maryland
would have the ability to make this reform a reality.
I've proposed the most comprehensive health care package on
the table. Now is the time to see if Congress is interested in
real reform. Mine is a plan that will fundamentally restructure
health care in America. Congress must begin to move now. Even
if all they do this year is just pass my insurance proposal
reform -- we'll at least get a start on changing the system.
If differences in Congress prevent passing my comprehensive
package this partisan election year, there are steps we can and
must take. Part of my plan entails significant reform of the
6
insurance markets, for which there is strong bipartisan support.
Senator Bentsen and Chairman Rostenkowski have proposed very
similar reforms that -- with some modification -- can, and
should, be passed immediately. These reforms will go a long way
toward curing the inequities in cost and coverage under existing
health insurance practices.
And there's another bipartisan reform package, proposed by
Senators Durenberger and Moynihan, that is in most respects con-
sistent with my plan and would promote much greater use of coor-
dinated care in Medicaid. East Baltimore knows this works. We
must make it easier for the rest of the country to follow your
road to better health care. In fact, as part of my plan for com-
prehensive reform, I want to make coordinated care the norm, not
the exception, for Medicaid. We must work together now to pass
these reforms that will provide millions of Americans with affor-
dable health coverage: and get a leg up on comprehensive reform.
Our plan does everything the government can and should do to
ensure the quality of life of each citizen of this great land.
It doesn't promise the moon. It does something more important:
it promises the future. Reform is never easy, but in health care
it's a must. We'll deliver what we say we can -- competition-
driven, market-based reform -- and we'll deliver it proudly.
I'll continue to push for it. We must get started today.
Thank you for all you do -- and for the brilliant example
EBMC provides for this nation. May God bless you all.
#
#
#
#
7
[ACKNOWLEDGEMENTS: ADD AT BEGINNING FOR FINAL COPY]
Thanks, Dr. Robert Heyssel [HESS-ill]. I understand you'll
retire in a few weeks as CEO of Johns Hopkins Health System,
after 20 years of building bridges with this community. You'll
leave a great legacy -- that new outpatient clinic which bears
your name and opens for business next Monday. We also have with
us today HHS Secretary Sullivan and Governor Schaefer. And I'm
glad to see Robert Winters, CEO of The Prudential, who's met with
me at the White House to discuss the future of health care. I
know some of you here just came downstairs for this event --
well, Bob came back from Europe just to be with us today.
I'm very glad to be here at Dunbar High, home of the Dunbar
Poets. With their unbeaten streak -- maybe Pete Pompey should
become my advisor. I was interested to hear about your school's
cooperative health career program with Johns Hopkins -- which is
not only on a summit in Baltimore, but is at the summit of
medical excellence. It's terrific that nearly 20% of Dunbar's
student body is involved in this innovative community outreach.
The school mascot -- the wise old owl -- would be proud.
SENT BY:Xerox Telecopier. 7020 ; 5-11-92 ; 4:53PM ;
The White House-
2024566218:# 2
Document No. 327243ss
WHITE HOUSE STAFFING MEMORANDUM
DATE:
5/11/92
ACTION/CONCURRENCE/COMMENT DUE BY: NOON TUES., MAY 12
PRESIDENTIAL REMARKS: COORDINATED HEALTH CARE EVENT
SUBJECT:
WEDNESDAY, MAY 13, 1992
BALTIMORE, MARYLAND
ACTION FYI
ACTION FYI
VICE PRESIDENT
HORNER
SKINNER
MCBRIDE
SCOWCROFT
MOORE
DARMAN
PETERSMEYER
BRADY
PORTER
BROMLEY
ROGICH
CALIO
ROLLINS
DEMAREST
SMITH
FITZWATER
YEUTTER
GRAY
FINDLAY
HOLIDAY
KAUFMAN
MCGROARTY
REMARKS:
copy to this office.
122, ext. 2930, NO LATER THAN NOON TUESDAY, MAY 12, with a
Please forward your comments directly to Dan McGroarty, rm
Thank you.
RESPONSE:
NEGDS To INCORPORATE DVNBARS TIE
To JOHNS Hopiens of EBMC.
WHY give THIS ADDRESS As DVNBAR?
PHILLIP D. BRADY
Assistant to the President
and Staff Secretary
Ext. 2702
(Hinchliffe/Gershowitz)
May 11, 1992 12 p.m.
BALTIMORE Draft One
PRESIDENTIAL REMARKS: COORDINATED HEALTH CARE EVENT
WEDNESDAY MAY 13, 1992
BALTIMORE, MARYLAND
[ACKNOWLEDGEMENTS] I've just had the chance to spend some
time four blocks from here, in the East Baltimore Medical Center.
Most impressive -- a terrific example the rest of the country can
follow. It's based on a special kind of public/private partner-
ship -- the kind I've been advocating -- in this case among Johns
Hopkins; The Prudential, a private insurance company; the state
of Maryland; and the federal government. This problem-solving
partnership heralds the future of health care in this country.
Thanks to this partnership, EBMC is the largest and fastest
growing Medicaid HMO in Maryland. It was there, eight years ago,
that Hopkins developed the concept of a Medicaid HMO. It's great
to see EBMC's success, because it proves what I strongly believe:
that health care and insurance industries can meet the challenge
of controlling health care costs while providing the finest
quality service. I congratulate you -- for while this HMO saves
mem-bers, employers and government money, health care remains
first-rate.
The key to EBMC's success, especially for Medicaid patients,
is that coordinated health care makes creative approaches
possible. It provides coordinated, quality care at a lower cost,
while emphasizing prevention and extra benefits, like EBMC's free
dental work and great pre-natal care in the Better Beginnings
Program. It's just plain commonsense -- we're better off keeping
2
people healthy rather than treating them after they're sick.
Preventive medicine improves the quality of life for patients --
and saves the health care system unnecessary expenditures.
Coordinated care works for all Americans, because it changes
the incentives. It's especially important for Medicaid recipi-
ents because of the difficulties they face in receiving care. It
helps ensure they're given care when they need it, where they
need it, and in a cost-effective way. EBMC proves that this kind
of care is a viable alternative to the fee-for-service system.
I'm excited to see so many pieces of my Comprehensive Health
Reform Program already successfully at work at EBMC. I introduced
this plan February 6, to address the twin challenges of expanding
access and containing cost -- while building on the strengths of
our present health care system. I was determined to treat the
root causes of our problems -- not just the symptoms. I think
the medical professionals here can understand that. Above all,
my plan is inspired by the words of British doctor Sir Frederick
Banting: "You must begin with an ideal and end with an ideal."
I'm appalled to think that in the greatest, most technologi-
cally advanced nation on the face of the earth, one out of seven
Americans has no health insurance. That is a disgrace and we
must not tolerate it. What we must do is clear -- We must
quarantee every American access to affordable health insurance.
In this election year, it seems like everyone's got their
own prescription for health care. Yes, people want quality care
they can afford and rely on. But we don't need to put government
3
between patients and their doctors. We don't need to build a new
federal bureaucracy. We need commonsense, comprehensive health
care reform -- and we need it now.
Sure, the other approaches can sound great, but what do you
really get? National Health Insurance means long lines, long
waiting lists and lower quality care. The idea for cost control
is flat out "price fixing" -- an idea we know won't work. Some
point to Canada: what they don't know, or just don't say, is
that Canada's health inflation now outpaces ours. Others point
to Medicare, which adopts set prices for many seniors' health
services. But Medicare inflation far outstripped private health
care inflation in the 70s and 80s and is still growing at 12% a
year. Cost containment is not its strong suit. Price fixing by
Congress has never worked before -- and it never will.
The so-called Play or Pay approach is equally unsound. Even
many proponents admit it will "melt down" into National Health
Insurance within a few years. And it does nothing to address the
underlying flaws of the health care system or change the dynamics
of the way health care is delivered -- except to, once again, fix
prices. It's a package full of empty promises. For those of us
who still think capitalism is a good idea; for those of us who
think markets and competition are what this country is built on
and stands for; for those of us who think competition breeds
quality and efficiency: I proposed my Comprehensive Reform Plan.
True, the health market hasn't always worked well. Most
people are insured, and therefore insulated against the
4
skyrocketing costs of health care. Millions of others are
uninsured and must be covered. But we haven't done anything to
reform private health care since WWII. We must make people more
aware of the costs and varying quality of care, so that they'll
be better consumers.
But there will always be a limit to how cost-sensitive we
can make individuals. When a kid falls off a bike and cracks his
head, not many parents question the cost of a CAT scan or an MRI
before given: their kid's health is too precious to bargain over.
So the competitive answer must be to group our consumers
together. We must combine employers, who often pay the bills,
and individuals into large, educated, informed purchasing groups
that can drive efficiencies back into the health care system.
These purchasing groups, or Health Insurance Networks, will pool
this information, will pool risk, and will pool consumer purchas-
ing power: to make the system more responsive to consumer demand.
My plan will dramatically reform our market-based system. It
will put quality care within the reach of every American family.
It will preserve choice. It will keep costs down and access up.
Part one of my plan says we'll cut the runaway costs of
health care by making the system more efficient. We'll call for
innovative approaches -- like the one we see right here in East
Baltimore. Part two of my plan says we'll wring out waste and
excess by reforming the system. Part three says we'll control
federal growth: since health care is the fastest growing part of
the federal budget.
5
And part four of my plan says we'll make health care more
accessible by making it more affordable. We'll provide up to
$3750 in health insurance credit or deductions for low- and
middle-income families and guarantee access to all low-income
Americans. These credits, combined with market reforms, will
bring health insurance to almost 30 million uninsured Americans.
Maryland is already getting on board this voucher approach
with bipartisan legislation. State Rep. Casper Taylor, with the
support of Blue Cross/Blue Shield of Maryland, outlined a $3600
standard health package to cover all low-income Marylanders
through tax credits. The Maryland "Consumer Choice" plan passed
the Maryland House a few weeks ago 134-0. This is the type of
state reform my plan encourages: under it, Maryland would have
much of the flexibility needed to make this reform a reality.
Since we unveiled our reforms three months ago, we've moved
ahead with our proposals, following through step by step on
everything we outlined in that historic plan. What's most
important is that we've put together a health care legislative
package -- and we can start to move now.
And now is the time to see if Congress is really interested
in passing useful legislation. We've submitted a great plan. It
will lift the hearts and ease the pain of literally millions of
Americans who today are sick and scared. Congress must move now.
Even if differences in Congress prevent passing my compre-
hensive package this partisan election year, there are steps we
must take. Part of my plan entails significant reform of the
6
insurance markets, for which there is strong bipartisan support.
Senator Bentsen and Chairman Rostenkowski have proposed very
similar reforms that can, and should, be passed immediately.
These reforms will go a long way toward curing the inequities in
cost and coverage under existing health insurance practices.
And there's another bipartisan reform package, proposed by
Senators Durenberger and Moynihan, that's consistent with my plan
and would promote much greater use of coordinated care in
Medicaid. As those at EMBC know -- this works. We must make it
easier for the rest of the country to follow your road to better
health care. We must work together now to pass these reforms
that will provide millions of Americans with affordable health
coverage -- and get a leg up on comprehensive reform.
Our plan does everything the government can and should do to
ensure the quality of life of each citizen of this great land.
It doesn't promise the moon -- it does something more important.
It promises the future. Reform is never easy, but in health care
it's a must. We'll deliver what we say we can -- competition-
driven, market-based reform -- and we'll deliver it proudly. I
will continue to push for it. We must get started today.
Thank you for all you do -- and for the brilliant example
EBMC provides for this nation. May God bless you all.
#
#
#
#
(Hinchliffe/Gershowitz)
May 11, 1992 12 p.m.
BALTIMORE Draft One
PRESIDENTIAL REMARKS:
COORDINATED HEALTH CARE EVENT
WEDNESDAY MAY 13, 1992
BALTIMORE, MARYLAND
[ACKNOWLEDGEMENTS] I've just had the chance to spend some
time four blocks from here, in the East Baltimore Medical Center.
Most impressive -- a terrific example the rest of the country can
follow. It's based on a special kind of public/private partner-
ship -- the kind I've been advocating -- in this case among Johns
Hopkins; The Prudential, a private insurance company; the state
of Maryland; and the federal government. This problem-solving
partnership heralds the future of health care in this country.
Thanks to this partnership, EBMC is the largest and fastest
growing Medicaid HMO in Maryland. It was there, eight years ago,
that Hopkins developed the concept of a Medicaid HMO. It's great
to see EBMC's success, because it proves what I strongly believe:
that health care and insurance industries can meet the challenge
of controlling health care costs while providing the finest
quality service. I congratulate you -- for while this HMO saves
mem-bers, employers and government money, health care remains
first-rate.
The key to EBMC's success, especially for Medicaid patients,
is that coordinated health care makes creative approaches
possible. It provides coordinated, quality care at a lower cost,
while emphasizing prevention and extra benefits, like EBMC's free
dental work and great pre-natal care in the Better Beginnings
Program. It's just plain commonsense -- we're better off keeping
2
people healthy rather than treating them after they're sick.
Preventive medicine improves the quality of life for patients --
and saves the health care system unnecessary expenditures.
Coordinated care works for all Americans, because it changes
the incentives. It's especially important for Medicaid recipi-
ents because of the difficulties they face in receiving care. It
helps ensure they're given care when they need it, where they
need it, and in a cost-effective way. EBMC proves that this kind
of care is a viable alternative to the fee-for-service system.
I'm excited to see so many pieces of my Comprehensive Health
Reform Program already successfully at work at EBMC. I introduced
this plan February 6, to address the twin challenges of expanding
access and containing cost -- while building on the strengths of
our present health care system. I was determined to treat the
root causes of our problems -- not just the symptoms. I think
the medical professionals here can understand that. Above all,
my plan is inspired by the words of British doctor Sir Frederick
Banting: "You must begin with an ideal and end with an ideal.'
I'm appalled to think that in the greatest, most technologi-
cally advanced nation on the face of the earth, one out of seven
Americans has no health insurance. That is a disgrace and we
must not tolerate it. What we must do is clear -- We must
guarantee every American access to affordable health insurance.
In this election year, it seems like everyone's got their
own prescription for health care. Yes, people want quality care
they can afford and rely on. But we don't need to put government
3
between patients and their doctors. We don't need to build a new
federal bureaucracy. We need commonsense, comprehensive health
care reform -- and we need it now.
Sure, the other approaches can sound great, but what do you
really get? National Health Insurance means long lines, long
waiting lists and lower quality care. The idea for cost control
is flat out "price fixing" -- an idea we know won't work. Some
point to Canada: what they don't know, or just don't say, is
that Canada's health inflation now outpaces ours. Others point
to Medicare, which adopts set prices for many seniors' health
services. But Medicare inflation far outstripped private health
care inflation in the 70s and 80s and is still growing at 12% a
year. Cost containment is not its strong suit. Price fixing by
Congress has never worked before -- and it never will.
The so-called Play or Pay approach is equally unsound. Even
many proponents admit it will "melt down" into National Health
Insurance within a few years. And it does nothing to address the
underlying flaws of the health care system or change the dynamics
of the way health care is delivered -- except to, once again, fix
prices. It's a package full of empty promises. For those of us
who still think capitalism is a good idea; for those of us who
think markets and competition are what this country is built on
and stands for; for those of us who think competition breeds
quality and efficiency: I proposed my Comprehensive Reform Plan.
True, the health market hasn't always worked well. Most
people are insured, and therefore insulated against the
4
skyrocketing costs of health care. Millions of others are
uninsured and must be covered. But we haven't done anything to
reform private health care since WWII. We must make people more
aware of the costs and varying quality of care, so that they'll
be better consumers.
But there will always be a limit to how cost-sensitive we
can make individuals. When a kid falls off a bike and cracks his
head, not many parents question the cost of a CAT scan or an MRI
before given: their kid's health is too precious to bargain over.
So the competitive answer must be to group our consumers
together. We must combine employers, who often pay the bills,
and individuals into large, educated, informed purchasing groups
that can drive efficiencies back into the health care system.
These purchasing groups, or Health Insurance Networks, will pool
this information, will pool risk, and will pool consumer purchas-
ing power: to make the system more responsive to consumer demand.
My plan will dramatically reform our market-based system. It
will put quality care within the reach of every American family.
It will preserve choice. It will keep costs down and access up.
Part one of my plan says we'll cut the runaway costs of
health care by making the system more efficient. We'll call for
innovative approaches -- like the one we see right here in East
Baltimore. Part two of my plan says we'll wring out waste and
excess by reforming the system. Part three says we'll control
federal growth: since health care is the fastest growing part of
the federal budget.
5
And part four of my plan says we'll make health care more
accessible by making it more affordable. We'll provide up to
$3750 in health insurance credit or deductions for low- and
middle-income families and guarantee access to all low-income
Americans. These credits, combined with market reforms, will
bring health insurance to almost 30 million uninsured Americans.
Maryland is already getting on board this voucher approach
with bipartisan legislation. State Rep. Casper Taylor, with the
support of Blue Cross/Blue Shield of Maryland, outlined a $3600
standard health package to cover all low-income Marylanders
through tax credits. The Maryland "Consumer Choice" plan passed
the Maryland House a few weeks ago 134-0. This is the type of
state reform my plan encourages: under it, Maryland would have
much of the flexibility needed to make this reform a reality.
Since we unveiled our reforms three months ago, we've moved
ahead with our proposals, following through step by step on
everything we outlined in that historic plan. What's most
important is that we've put together a health care legislative
package -- and we can start to move now.
And now is the time to see if Congress is really interested
in passing useful legislation. We've submitted a great plan. It
will lift the hearts and ease the pain of literally millions of
Americans who today are sick and scared. Congress must move now.
Even if differences in Congress prevent passing my compre-
hensive package this partisan election year, there are steps we
must take. Part of my plan entails significant reform of the
6
insurance markets, for which there is strong bipartisan support.
Senator Bentsen and Chairman Rostenkowski have proposed very
similar reforms that can, and should, be passed immediately.
These reforms will go a long way toward curing the inequities in
cost and coverage under existing health insurance practices.
And there's another bipartisan reform package, proposed by
Senators Durenberger and Moynihan, that's consistent with my plan
and would promote much greater use of coordinated care in
Medicaid. As those at EMBC know -- this works. We must make it
easier for the rest of the country to follow your road to better
health care. We must work together now to pass these reforms
that will provide millions of Americans with affordable health
coverage -- and get a leg up on comprehensive reform.
Our plan does everything the government can and should do to
ensure the quality of life of each citizen of this great land.
It doesn't promise the moon -- it does something more important.
It promises the future. Reform is never easy, but in health care
it's a must. We'll deliver what we say we can -- competition-
driven, market-based reform -- and we'll deliver it proudly. I
will continue to push for it. We must get started today.
Thank you for all you do -- and for the brilliant example
EBMC provides for this nation. May God bless you all.
#
#
#
#
(Hinchliffe/Gershowitz)
May 11, 1992
12 p.m.
BALTIMORE Draft One
PRESIDENTIAL REMARKS: COORDINATED HEALTH CARE EVENT
WEDNESDAY MAY 13, 1992
BALTIMORE, MARYLAND
[ACKNOWLEDGEMENTS] I've just had the chance to spend some
time four blocks from here, in the East Baltimore Medical Center.
Most impressive -- a terrific example the rest of the country can
follow. It's based on a special kind of public/private partner-
ship -- the kind I've been advocating -- in this case among Johns
Hopkins; The Prudential, a private insurance company; the state
of Maryland; and the federal government. This problem-solving
partnership heralds the future of health care in this country.
Thanks to this partnership, EBMC is the largest and fastest
growing Medicaid HMO in Maryland. It was there, eight years ago,
that Hopkins developed the concept of a Medicaid HMO. It's great
to see EBMC's success, because it proves what I strongly believe:
that health care and insurance industries can meet the challenge
of controlling health care costs while providing the finest
quality service. I congratulate you -- for while this HMO saves
mem-bers, employers and government money, health care remains
first-rate.
The key to EBMC's success, especially for Medicaid patients,
is that coordinated health care makes creative approaches
possible. It provides coordinated, quality care at a lower cost,
while emphasizing prevention and extra benefits, like EBMC's free
dental work and great pre-natal care in the Better Beginnings
Program. It's just plain commonsense -- we're better off keeping
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people healthy rather than treating them after they're sick.
Preventive medicine improves the quality of life for patients --
and saves the health care system unnecessary expenditures.
Coordinated care works for all Americans, because it changes
the incentives. It's especially important for Medicaid recipi-
ents because of the difficulties they face in receiving care. It
helps ensure they're given care when they need it, where they
need it, and in a cost-effective way. EBMC proves that this kind
of care is a viable alternative to the fee-for-service system.
I'm excited to see so many pieces of my Comprehensive Health
Reform Program already successfully at work at EBMC. I introduced
this plan February 6, to address the twin challenges of expanding
access and containing cost -- while building on the strengths of
our present health care system. I was determined to treat the
root causes of our problems -- not just the symptoms. I think
the medical professionals here can understand that. Above all,
my plan is inspired by the words of British doctor Sir Frederick
Banting: "You must begin with an ideal and end with an ideal.'
I'm appalled to think that in the greatest, most technologi-
cally advanced nation on the face of the earth, one out of seven
Americans has no health insurance. That is a disgrace and we
must not tolerate it. What we must do is clear -- We must
guarantee every American access to affordable health insurance.
In this election year, it seems like everyone's got their
own prescription for health care. Yes, people want quality care
they can afford and rely on. But we don't need to put government
3
between patients and their doctors. We don't need to build a new
federal bureaucracy. We need commonsense, comprehensive health
care reform -- and we need it now.
Sure, the other approaches can sound great, but what do you
really get? National Health Insurance means long lines, long
waiting lists and lower quality care. The idea for cost control
is flat out "price fixing" -- an idea we know won't work. Some
point to Canada: what they don't know, or just don't say, is
that Canada's health inflation now outpaces ours. Others point
to Medicare, which adopts set prices for many seniors' health
services. But Medicare inflation far outstripped private health
care inflation in the 70s and 80s and is still growing at 12% a
year. Cost containment is not its strong suit. Price fixing by
Congress has never worked before -- and it never will.
The so-called Play or Pay approach is equally unsound. Even
many proponents admit it will "melt down" into National Health
Insurance within a few years. And it does nothing to address the
underlying flaws of the health care system or change the dynamics
of the way health care is delivered -- except to, once again, fix
prices. It's a package full of empty promises. For those of us
who still think capitalism is a good idea; for those of us who
think markets and competition are what this country is built on
and stands for; for those of us who think competition breeds
quality and efficiency: I proposed my Comprehensive Reform Plan.
True, the health market hasn't always worked well. Most
people are insured, and therefore insulated against the
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skyrocketing costs of health care. Millions of others are
uninsured and must be covered. But we haven't done anything to
reform private health care since WWII. We must make people more
aware of the costs and varying quality of care, so that they'll
be better consumers.
But there will always be a limit to how cost-sensitive we
can make individuals. When a kid falls off a bike and cracks his
head, not many parents question the cost of a CAT scan or an MRI
before given: their kid's health is too precious to bargain over.
So the competitive answer must be to group our consumers
together. We must combine employers, who often pay the bills,
and individuals into large, educated, informed purchasing groups
that can drive efficiencies back into the health care system.
These purchasing groups, or Health Insurance Networks, will pool
this information, will pool risk, and will pool consumer purchas-
ing power: to make the system more responsive to consumer demand.
My plan will dramatically reform our market-based system. It
will put quality care within the reach of every American family.
It will preserve choice. It will keep costs down and access up.
Part one of my plan says we'll cut the runaway costs of
health care by making the system more efficient. We'll call for
innovative approaches -- like the one we see right here in East
Baltimore. Part two of my plan says we'll wring out waste and
excess by reforming the system. Part three says we'll control
federal growth: since health care is the fastest growing part of
the federal budget.
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And part four of my plan says we'll make health care more
accessible by making it more affordable. We'll provide up to
$3750 in health insurance credit or deductions for low- and
middle-income families and guarantee access to all low-income
Americans. These credits, combined with market reforms, will
bring health insurance to almost 30 million uninsured Americans.
Maryland is already getting on board this voucher approach
with bipartisan legislation. State Rep. Casper Taylor, with the
support of Blue Cross/Blue Shield of Maryland, outlined a $3600
standard health package to cover all low-income Marylanders
through tax credits. The Maryland "Consumer Choice" plan passed
the Maryland House a few weeks ago 134-0. This is the type of
state reform my plan encourages: under it, Maryland would have
much of the flexibility needed to make this reform a reality.
Since we unveiled our reforms three months ago, we've moved
ahead with our proposals, following through step by step on
everything we outlined in that historic plan. What's most
important is that we've put together a health care legislative
package -- and we can start to move now.
And now is the time to see if Congress is really interested
in passing useful legislation. We've submitted a great plan. It
will lift the hearts and ease the pain of literally millions of
Americans who today are sick and scared. Congress must move now.
Even if differences in Congress prevent passing my compre-
hensive package this partisan election year, there are steps we
must take. Part of my plan entails significant reform of the
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insurance markets, for which there is strong bipartisan support.
Senator Bentsen and Chairman Rostenkowski have proposed very
similar reforms that can, and should, be passed immediately.
These reforms will go a long way toward curing the inequities in
cost and coverage under existing health insurance practices.
And there's another bipartisan reform package, proposed by
Senators Durenberger and Moynihan, that's consistent with my plan
and would promote much greater use of coordinated care in
Medicaid. As those at EMBC know -- this works. We must make it
easier for the rest of the country to follow your road to better
health care. We must work together now to pass these reforms
that will provide millions of Americans with affordable health
coverage -- and get a leg up on comprehensive reform.
Our plan does everything the government can and should do to
ensure the quality of life of each citizen of this great land.
It doesn't promise the moon -- it does something more important.
It promises the future. Reform is never easy, but in health care
it's a must. We'll deliver what we say we can -- competition-
driven, market-based reform -- and we'll deliver it proudly. I
will continue to push for it. We must get started today.
Thank you for all you do -- and for the brilliant example
EBMC provides for this nation. May God bless you all.
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Demarest
MAY 11 92 1:19 FROM FHFB CHMN OFFICE
TO HUD SEC
PAGE. 002
Federal
Housing
Finance
NEWS
Board
1777 F Street. N.W.. Washington, D.C. 20006
(202) 408-2986
DRAFT
DRAFT
FOR RELEASE
CONTACT:
Charles H. Powers
May 12, 1992
(202) 408-2986
FHFB 92-24
FEDERAL HOUSING FINANCE BOARD ANNOUNCES AVAILABILITY OF $600
MILLION IN COMMUNITY INVESTMENT CREDIT FOR LOS ANGELES
Washington, D.C. -- The Federal Housing Finance Board today
announced the Federal Home Loan Bank System will make $600
million available to finance the rebuilding of housing and
businesses in Los Angeles.
"The Bank System will make these funds available as loans
through its community Investment Program to financial
institutions at favorable interest rates. In turn, these funds
can be loaned to assist in helping rebuild the damaged
communities," Daniel F. Evans, Jr., Finance Board Chairman said
today.
The Federal Home Loan Bank of San Francisco will act as the
lead District Bank for the twelve District Banks that compose the
Bank System, a government-sponsored enterprise dedicated to
housing finance throughout the nation.
WHITE HOUSE/OCA
003
MAY 11 .92 1:19
FROM FHFB CHMN OFFICE
TO HUD SEC
PAGE. 003
DRAFT
$600 Million Credit Cont'd.
Page 2
In addition, the Bank System's Affordable Housing Program
(AHP) is providing subsidized loans to further assist low and
moderate income families in Los Angeles. Presently, $1 million
in AHP subsidy is leveraging $22.5 million to provide 206 housing
units for such families. The Finance Board will now expedite
processing of new AHP applications for Los Angeles. There are
currently pending 11 AHP project applications that could provide
$3 million of subsidy, which could leverage up to $60 million in
additional low and moderate income housing in the area.
The Community Investment Program (CIP) provides loans
through Bank System members for community-oriented mortgage
lending including:
--
financing the purchase or rehabilitation of owner-
occupied or rental housing for families whose income
does not exceed 115 percent of an area's median income,
-- financing commercial or economic development activities
that benefit low- and moderate-income families or
activities located in low- and moderate-income
neighborhoods,
projects may also combine housing and commercial or
economic development activities.
SECRETARI
WHITE HOUSE/UCA
004
MAY 11 '92 1:20 FROM FHFB CHMN OFFICE
TO HUD SEC
PAGE. 004
DRAFT
$600 Million Credit Cont'd.
Page 3
CIP advances are provided to Bank System member financial
institutions at the cost of consolidated FHLBank obligations,
plus reasonable administrative costs. In 1991 close to $1
billion of CIP advances-were used in financing 29,000 housing
units.
The Affordable Housing Program subsidy funds are used to
finance the following:
-- homeownership by families with incomes at or below 80
percent of the median income for the area; or
-- finance the purchase, construction, or rehabilitation
of rental housing, at least 20 percent of the units of
which will be occupied by and affordable for very low-
income households for the remaining useful life of such
housing or the mortgage term.
Since the AHP's inception two years ago, close to $150
million in subsidies were contributed by the Bank System. With
leveraging, that's more than $2 billion of development and 43,500
housing units.
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