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Greater Cleveland Growth Association 2/6/92 [OA 6096] [1]
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Greater Cleveland Growth Association 2/6/92 [OA 6096] [1]
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26
17
6
4
George Bush, 1992
Administration of George Bush, 1992 / Feb. 6
217
: at 10:38 a.m. at
by superseded to the extent of such inconsist-
This notice is submitted in accordance
n his remarks, he
ency.
with section 502(a)(1) of the Trade Act of
Eastern Petroleum
(3) The amendment made by this procla-
1974.
obert Buchert, of
mation shall be effective with respect to arti-
Sincerely,
uction and Devel-
cles both: (i) imported on or after January
George Bush
nnati, OH; John
1, 1976, and (ii) entered, or withdrawn from
dent of the United
warehouse for consumption, on or after 15
Note: Identical letters were sent to Thomas
and the following
days after the date of publication of this proc-
S. Foley, Speaker of the House of Rep-
Chisholm, chair-
lamation in the Federal Register.
resentatives, and Dan Quayle, President of
nt, and Ted Olsen,
In Witness Whereof, I have hereunto set
the Senate.
my hand this fifth day of February, in the
year of our Lord nineteen hundred and nine-
ty-two, and of the Independence of the Unit-
ed States of America the two hundred and
Remarks to the Greater Cleveland
Γo Amend the
sixteenth.
Growth Association in Cleveland,
Preferences
Ohio
George Bush
February 6, 1992
ited States
[Filed with the Office of the Federal Register,
Thank you very much for that welcome
10:37 a.m., February 6, 1992]
back to Cleveland. And first let me thank
Dick Pogue, the chairman of the Greater
Note: This proclamation was published in
Cleveland Growth Association, and all who
501 and 502 of the
the Federal Register on February 7.
help make this wonderful forum possible. I'm
mended (the 1974
pleased to be back here in Cleveland, the
2462), and having
capital city of the North Coast.
ity criteria set forth
Hello to Bob Horton, who I understand
ed that it is appro-
Letter to Congressional Leaders on
not only warmed up the crowd but made it
a, Latvia, and Lith-
Beneficiary Trade Status for Estonia,
very difficult for me to come on as the next
oping countries for
Latvia, and Lithuania
speaker. I salute what he and so many other
:ed System of Pref-
February 5, 1992
business leaders in this community have
done and are doing. You always get this feel-
974 Act (19 U.S.C.
Dear Mr. Speaker: (Dear Mr. President:)
ing of cooperation between the business
ident to embody in
I am writing to inform you of my intert
community and the government of Cleve-
hedule of the Unit-
to add Estonia, Latvia, and Lithuania to the
land, the city government. I had that when
tance of the provi-
list of beneficiary developing countries under
I first came here and Mayor Ralph Perk was
other acts affecting
the Generalized System of Preferences
in office, and particularly did I get that feel-
ions thereunder.
(GSP). The GSP program offers duty-free ac-
ing when George Voinovich came in as your
,eorge Bush, Presi-
cess to the U.S. market and is authorized by
mayor and energized this place to a fare-
S of America, acting
the Trade Act of 1974.
thee-well. And business pitched right in. And
d in me by the Con-
you have this wonderful community spirit
the United States
In extending nondiscriminatory, most-fa-
that this organization really epitomizes, Dick.
not limited to title
vored-nation treatment to Estonia, Latvia,
And I am grateful to be here.
1974 Act, do pro-
and Lithuania, the Congress provided that
And so let me get on with just saying I'm
I should take prompt action to grant GSP
very pleased to have been introduced by
(ii)(A) to the HTS,
benefits to the Baltic States, provided they
George Voinovich, the great Governor of this
ose products are el-
each satisfied the eligibility requirements. I
State now. And may I salute Mike DeWine,
: GSP, is modified
have carefully considered the criteria identi-
who is over here, the Lieutenant Governor.
Latvia", and "Lith-
fied in sections 501 and 502 of the Trade
We've got some other friends with us, too.
der in the enumera-
Act of 1974. In light of these criteria, and
I know that Bob Taft is out here, the sec-
tries.
particularly the Baltic nations' ongoing politi-
retary of state. Three distinguished Members
previous proclama-
cal and economic reforms, I have determined
of the United States Congress came with us,
rs inconsistent with
that it is appropriate to extend GSP benefits
Ralph Regula, Mike Oxley, and Dave Hob-
clamation are here-
to Estonia, Latvia, and Lithuania.
son. And I'm sure I'll forget somebody, but
218
Feb. 6 / Administration of George Bush, 1992
nevertheless I see our State senate president,
us the worry that people feel, the all-too-fa-
Stan Aronoff, sitting over here. So that takes
miliar fear about what happens to their
care of it. We've got good representation
health care if they change jobs or, worse still,
from Ohio's government; we've got rep-
if they lose their jobs. And in these hard
resentation from the wonderful congressional
times, we simply cannot accept the fact that
delegation; and we have outstanding rep-
one in every seven Americans is uninsured.
resentation here from the medical commu-
There's a better way. And my plan puts
nity and, of course, from the business com-
the emphasis on expanding access while pre-
munity at large.
serving the choice people now have over the
Good things are happening here for the
type of health care coverage and health care
Cleveland Cavs. [Laughter] In fact, I told the
they receive. My plan will give Americans a
Governor I was going to be speaking today
greater sense of security, help ease the fears
about the number one health issue on every
that so many Americans have that changing
Clevelander's mind. He said, "Mr. President,
jobs will cost them their health coverage. And
Mark Price's left knee is just fine." [Laugh-
the key here is portability, changing the sys-
ter]
tem to ensure people that they will always
People who know northern Ohio know
have access to health insurance no matter
that this region's on the move. In addition
where they work. And finally, my plan will
to the world-renowned Cleveland Clinic,
cut costs. It helps us make health insurance
now the city's number one employer, north-
more affordable, and more affordable means
ern Ohio is also home to some of the most
more accessible.
innovative approaches to health care. COSE
And my plan will preserve what works and
and Cleveland Health Quality Choice are
reform what doesn't. And above all, it will
pioneers. Communities across the country
ensure every American universal access to af-
can follow your lead to create workable solu-
fordable health insurance.
tions to health care challenges. And I had
We stand at a crossroads. We can move
a briefing in Washington from the leaders
forward dramatically to reform our market-
of these organizations, and that really is why
based system, or we can force ourselves to
I've chosen to come to Cleveland this morn-
swallow a cure worse than the disease. Some
ing to address the health care crisis in our
people have scribbled out a prescription for
country and lay out my four-point program
disaster. They want to nationalize our health
for comprehensive health care reform.
system, put the Government in control of the
Reform is urgent for more reasons than
system: Well, you let Government control the
one. Right now, far too many Americans are
prices, let Government ration the kind of
uninsured, and those who are insured pay
health care people get, let Government tell
too much for health care. And we're going
people looking for care how much they'll get,
to do something about that.
what kind, and when.
The one thing this crisis isn't about, and
Nationalized systems cover everyone. But
I was reminded of this in my visit to the hos-
keep in mind the drawbacks that come with
pital just now, the one thing it is not about
a nationalized system: Long waiting lists for
is the quality of care. American health care
surgery, shortages of high-tech equipment
is first-rate. It is the best in the entire world.
responsible for so many of the miracles of
And right now, the vast majority of Ameri-
modern medicine. Let me cite just one exam-
cans have access to that health care system.
ple for you. The Cleveland Clinic performs
But the cost has skyrocketed from $74 billion
10 coronary bypass surgeries a day, I'm told,
in 1970 to $800 billion today. And if we keep
high-tech, high quality surgery without any
going at the same rate, that $800 billion will
wait. But if you live in British Columbia, the
double to $1.6 trillion by the year 2000.
wait for coronary bypass surgery is 6 months.
These numbers alone would make the case
It's no wonder so many people from abroad
for reform. They tell us there's a connection
come to American hospitals for surgery.
we simply can't ignore between what we pay
When you nationalize health care, you
for health care and the long-term health of
push costs higher, far higher. Some studies
our economy. But cold statistics don't show
estimate that nationalized health care would
George Bush, 1992
Administration of George Bush, 1992 / Feb. 6
219
feel, the all-too-fa-
cost the average American family a huge new
what I'm talking about. And there's nothing
happens to their
tax burden; for the Nation, a staggering $250
wrong discussing that, trying to do better in
jobs or, worse still,
billion to $500 billion a year in new taxes.
this field. Tomorrow, in San Diego, I'll focus
And in these hard
Such a massive tax increase is simply unac-
in more detail on the ways prevention can
accept the fact that
ceptable, and the American people should
help people live healthier lives and help keep
icans is uninsured.
not be asked to accept it. And for that price,
our economy healthy, too.
And my plan puts
you get the worst of both worlds: No one
But today, I want to focus on the health
g access while pre-
has an incentive to control costs, and every-
care system, on this comprehensive, market-
now have over the
one pays.
based reform plan I have. The fact is, we
age and health care
But there are other proposals out there
do not have to create a new Government bu-
11 give Americans a
that sound simple but are every bit as harm-
reaucracy to give Americans access to afford-
help ease the fears
ful. One's called "play or pay." Each em-
able, quality health care. We need a system
have that changing
ployer must play, provide insurance for em-
that delivers, a system that works for Amer-
ealth coverage. And
ployees, or pay a payroll tax to finance Gov-
ica, a system that puts quality care within
1, changing the sys-
ernment health coverage. Business men and
reach of every American family.
at they will always
women tell me horror stories about health
Our system should be built on choice, not
surance no matter
care costs spiraling out of control. Well, "play
central control. It should keep costs down
nally, my plan will
or pay" will leave a lot of small businesses,
and open up access. But above all, it should
ke health insurance
businesses struggling on the edge of survival
allow all Americans to rest secure when it
re affordable means
right now, with a tough choice. They can cut
comes to health care, to ease their worry that
workers' wages to pay for mandated health
if they change jobs, if they or their kids de-
erve what works and
care; they can fire some workers to cover the
velop serious health problems, they'll still be
id above all, it will
workers they keep; or they can raise prices
able to count on the coverage they need.
niversal access to af-
and pass along the cost to the consumer.
Now, my comprehensive four-point plan
Some studies put the cost in jobs lost under
meets every one of these commonsense tests.
bads. We can move
"play or pay" as high as half a million or
And here's how it works. Point one, we will
reform our market-
more. Lower wages, lost jobs, higher costs:
make health care more accessible by making
1 force ourselves to
Any way you look at it, that's the wrong
health insurance more affordable. For low-
n the disease. Some
choice for America.
income individuals and families, I propose
at a prescription for
Step away from the rhetoric, strip it out
a health insurance credit, up to $3,750 a year
ntionalize our health
of there, and "play or pay" just creates a
to guarantee people, even people too poor
nent in control of the
back-door route to nationalized health care.
to file taxes, the ability to purchase private
vernment control the
And it encourages employers to stop offering
health insurance. That will give these families
ration the kind of
benefits, throw the problem in the Govern-
a certificate or voucher, to be used strictly
let Government tell
ment's lap, and dump millions of fully in-
for health care, worth more than $300 a
IOW much they'll get,
sured workers into a public plan like Medic-
month. They can use it to buy into the plan
aid. And because the new employer taxes in
their employers offer but they could never
cover everyone. But
"play or pay" don't pay for the program, the
afford, or they can shop for whatever private
backs that come with
American taxpayer will obviously foot the bill.
plan suits them best. That's the American
Long waiting lists for
And I am not about to let that happen. You
commitment to choice at its best.
ligh-tech equipment
won't hear this from the people pushing
For middle-income individuals and fami-
y of the miracles of
"play or pay." Ask them about the side effects
lies, I propose a health insurance tax deduc-
e cite just one exam-
of their proposal, and they'll say, "Take two
tion of $3,750. American families with in-
and Clinic performs
aspirin, and call me after the election."
comes under $80,000 will receive new help
eries a day, I'm told,
I don't believe people want to be shoveled
from either the credit or the tax deduction.
surgery without any
into some new health care bureaucracy. They
Let me tell you what that means: new help
British Columbia, the
want good health. A large part of the answer
to purchase health insurance for 95 million
surgery is 6 months.
is prevention. And every one of us can make
Americans. And once again, this insurance
people from abroad
changes in our behavior to reduce the risk
will be portable. People who change jobs
tals for surgery.
of disease and illness. And pardon me for
would have insurance regardless of their
ze health care, you
being just a little bit old-fashioned, but what
health, and this is important, or regardless
higher. Some studies
we're talking about is behavior: drugs, alco-
of their family's health. But best of all, my
ed health care would
hol abuse, risky sexual behavior. You know
plan will bring health care coverage to almost
220
Feb. 6 / Administration of George Bush, 1992
30 million uninsured Americans, security to
excesses of mandated benefits. When States
people who for far too long have had to do
now order health insurers to cover 1,000 dif-
without. That's the first point in this four-
ferent types of treatment, something's gone
point plan, access.
wrong. Next thing they'll be covering mani-
Point two, we will cut the runaway costs
cures for Millie. [Laughter] It's gone too far.
of health care by making the system more
And I think everybody knows it. And we
efficient. Today, I'm asking you to learn a
should challenge the States to do something
new acronym, HIN, health insurance net-
about the excessive mandates that shoot
works. Insurance costs obey the law of large
these costs right up through the roof.
numbers. The larger the group being in-
Fourth and finally, we will get the growth
sured, the lower the cost per individual. Pool-
in Government health programs under con-
ing, pooling lowers insurance costs and sig-
trol. Right now, Government health care pro-
nificantly cuts administrative costs. HIN's
grams-can claim a dubious distinction: They
will provide incentives for small companies
are the fastest growing parts in the Federal
to do what Cleveland's COSE group has
budget. For those of you interested in his-
done when it brought 10,000 small busi-
tory, go back and listen to what was said
nesses together to make a joint purchase of
about these programs at their inception. Go
health care. The Nation should listen and fol-
back and hear the rhetoric on the floor of
low.
the United States Congress. And now com-
Another way to drive costs down, make ev-
pare that to what actually has happened in
eryone a better health care consumer. Right
these costs. This year alone, this year alone,
now, most people pay more attention to the
let me repeat that, Medicaid costs will in-
price of toothpaste then the comparative
crease by 38 percent. We will not, repeat,
costs of health care. People don't waste much
not cut benefits. We can make real savings
time thinking about the costs of their care,
simply by reducing this huge rate of increase.
but in the end we all pay the price. We need
We must bring runaway costs under control.
to follow the lead of initiatives like Cleveland
Smart, sensible efficiencies will help our re-
Health Quality Choice, programs that give
form plan pay for itself.
people shopping for health care a kind of
The Federal Government should also give
blue book for medical costs. Innovations like
States flexibility to design these new univer-
these will help all of us keep the costs of
sal access programs for the poor, programs
quality health care as low as possible.
that will provide quality services to all their
Point three, we will wring out waste and
citizens. I've just met with Governor
excess in the present system. We've targeted
Voinovich and the rest of the Governors. Re-
medical malpractice for reform. It is time to
gardless of party, Democrat or Republican,
put an end to these astronomical, sky's-the-
it doesn't matter, they want flexibility. And
limit lawsuits. You shouldn't have to pay a
we must give it to them. Right here in Ohio,
lawyer when you go to the doctor. And our
your Governor has proposed health care re-
doctors, the most able and dedicated in the
forms that will do for this State what we want
world, shouldn't be living in fear of these out-
to do on the Federal level. States should be
rageous lawsuits. And high malpractice pre-
able to use new Federal resources to design
miums mean higher doctors' bills, higher
programs that work, not some one-size-fits-
hospital costs, costs passed along not only to
all solution imposed by Washington, DC.
the patient but to every American taxpayer.
Providing affordable care, efficient care,
Now, I have challenged the health insur-
wringing out excess and waste, and control-
ance industry to cut redtape, to share com-
ling Federal growth. These four points will
mon forms, to simplify and speed up claims
create the kind of market-based reform plan
processing. And here's a challenge for the
that will give Americans the kind of health
next 4 years: There is no reason almost all
care they want and deserve and put an end
health insurance claims can't be processed
to the worry that keeps them awake at night.
electronically. That single step would elimi-
Remember what people want. People want
nate a mountain of health care paperwork
quality care, care they can afford, and care
and pare back costs. We've got to attack the
they can count on, care they can rely on. I
of George Bush, 1992
Administration of George Bush, 1992 / Feb. 6
221
enefits. When States
keep coming back to what works for this
day. It started in Cleveland where I an-
rs to cover 1,000 dif-
country. Think about the challenges that we
nounced the fundamentals of a new national
it, something's gone
face as a Nation. Anyone who is concerned
approach for health care which I intend to
11 be covering mani-
about competitiveness has to see controlling
work very hard for. But I want to thank Dr.
ter] It's gone too far.
health care costs as key to a healthy economy.
Brandness and single out the Governor of
knows it. And we
We've got to make certain our reform cor-
the State who has been most hospitable to
ites to do something
rects our weaknesses without destroying our
me since we've been here. Also Barbara
handates that shoot
strengths. When we talk about health care,
Vucanovich, who is a Congressman here, a
ugh the roof.
we're talking about matters of the most per-
great friend of mine of long-standing, and
e will get the growth
sonal nature, in some cases literally life and
simply say that I'm very pleased to be here
programs under con-
death and decisions that go with it. We don't
to thank all of you for this afternoon's tour.
nent health care pro-
need to put Government between patients
You can't help but when you walk through
ous distinction: They
and their doctors. We don't need to create
these halls and see the incredible work and
parts in the Federal
another wasteful Federal bureaucracy. As
dedication of the people, as we saw both at
ou interested in his-
President I simply will not let that happen.
the neonatal care and the burn care center,
en to what was said
We need commonsense, comprehensive
you can't help but count your blessings for
it their inception. Go
health care reform, and we need it now. And
those who are devoting their lives to helping
toric on the floor of
my plan I really believe is the right plan, a
others. When you see somebody treating ba-
gress. And now com-
plan that meets our obligation to all Ameri-
bies like that, tiny preemies, or those ravaged
ally has happened in
cans by putting hope and health within their
by burns, it just, at least in my heart, evokes
lone, this year alone,
reach.
tremendous gratitude and admiration for
edicaid costs will in-
Cleveland has led the way. Your hospitals,
what you do. So, I hope you know that people
We will not, repeat,
COSE, citizens in this community are way
outside the medical profession are extraor-
an make real savings
out front for these principles. And it's most
dinarily grateful to those who give of them-
huge rate of increase.
appropriate that I give this speech to the Na-
selves as you all do.
y costs under control.
tion on health care reform right here in this
I did release this comprehensive health
cies will help our re-
city that is leading the way.
care program earlier today. And let me just,
Once again, my thanks for this warm
without giving you the full load, summarize
ment should also give
Cleveland welcome. May God bless you all
a little bit. I know you're used to extended
ign these new univer-
and the United States of America. Thank you
debates about health care. You probably get
r the poor, programs
very, very much.
a lot of requests for free advice on this sub-
ty services to all their
ject and many others. But I think everyone
met with Governor
Note: The President spoke at 12:36 p.m. at
understands that all of you do something that
of the Governors. Re-
the Stouffer Tower City Plaza Hotel. In his
politicians sometimes forget, and that is that
nocrat or Republican,
remarks, he referred to Robert B. Horton,
America's medical system offers the best care
want flexibility. And
chairman of British Petroleum, and Mark
in the world.
n. Right here in Ohio,
Price, a member of the Cleveland Cavaliers
It's not simply that we start with the sci-
oposed health care re-
basketball team. He also referred to the asso-
entific and research end with far more Nobel
this State what we want
ciation's Council of Small Enterprises
Prize winners in medicine than any other
level. States should be
(COSE).
country. It is just generally the quality of
al resources to design
care. And when people from other countries
not some one-size-fits-
seek the best possible care, you just have to
Washington, DC.
look, where do they go? Well, they come to
e care, efficient care,
Remarks to the Staff of the
the United States of America.
nd waste, and control-
University Medical Center of
And with all the problems and all the
These four points will
Southern Nevada in Las Vegas,
breathless press reports about health care, I
ket-based reform plan
Nevada
think of the guy who got in a car accident.
ins the kind of health
February 6, 1992
And when he got to the hospital, the doctor
eserve and put an end
set his broken bones, examined him care-
is them awake at night.
Thank you all very much. And again, I
fully, and assured him that he could go home
ople want. People want
apologize if we've kept this distinguished
the next day. The next day came, and the
y can afford, and care
group, busy people, waiting. But we're de-
doctor rushed to the patient's room with a
are they can rely on. I
lighted to be here. It's kind of a hit-and-run
look of great anxiety and concern. "Is some-
Document No. 304159
WHITE HOUSE STAFFING MEMORANDUM
DATE: 2/1/92
ACTION/CONCURRENCE/COMMENT DUE BY: MONDAY, 4:00 PM, 2/3/92
PRESIDENTIAL REMARKS: GREATER CLEVELAND GROWTH ASSOCIATION
CLEVELAND, OHIO
SUBJECT:
FEBRUARY 6, 1992
ACTION FYI
ACTION FYI
VICE PRESIDENT
1
HORNER N/C
SKINNER
MCCLURE No!
]
SCOWCROFT
PETERSMEYER
DARMAN scully
1
PORTER 2705 HANNS
BRADY
/ROGICH
242hmg
BROMLEY
SMITH
FINDLAY
CARD
DEMAREST
SNOW
KAUFMAN 2135 N/C
FITZWATER
2898 Junet
GRAY
7312 Renguist
BOSKIN 5042 N/C
HOLIDAY HHS?
REMARKS:
Please forward your' comments directly to Tony Snow, Rm. 122, x2930,
with a copy to this office NO LATER THAN 4:00 PM, MONDAY, FEBRUARY 3.
Thank you.
RESPONSE:
PHILLIP D. BRADY
Assistant to the President
and Staff Secretary
Ext. 2702
McGroarty/Bunton
January 31, 1992
3:00 pm
02 JAN31 P4: 29
[health]
PRESIDENTIAL REMARKS:
GREATER CLEVELAND GROWTH ASSOCIATION
CLEVELAND, OHIO
FEBRUARY 6, 1992
XX:00 A.M.
[Introductory acknowledgements.] I'm pleased to be back in
Cleveland, capital city of the North Coast. [[opening humor...]]
People who know Northern Ohio know this region's outgrowing
the old rustbelt image. Cleveland Clinic is world-renown -- and
it is now the city's number one employer. Northern Ohio is also
home to some of the most innovative approaches to health care.
/
That's why I've chosen this morning to address the health care
crisis -- and lay out my five-point program for comprehensive
health care reform. //
Reform is urgent -- for more reasons than one. / The
crisis I mentioned isn't in quality of care. American health
care is first-rate, the best in the world. But the cost has
skyrocketted: from XXX in 19-- to $800 billion dollars today.
And if we keep going at the same rate, that $800 billion will
double to $1.6 trillion by the year 2000.
These numbers alone would make the case for reform. But
cold statistics don't show us the worry people feel -- the all-
too-familiar fear about what happens to their health care if they
lose their job -- or even if they leave their job for a better
one. // Right now, one in every seven Americans is uninsured.
And in these hard times, millions more Americans worry that if
2
they lose their job, they lose more than their paycheck -- they
lose their health insurance as well. //
There's a better way. But the question is whether we'll
settle on sensible reforms -- or whether we'll force ourselves to
swallow a cure worse than the disease. Before I detail my plan,
let's take a look at some of the alternatives out there, and what
they'd do for -- or to -- America's health.
Begin with a prescription for disaster: we can nationalize
the health system. Put government in control of the system: let
government control the prices, l'et government ration the kind of
health care people get -- let government tell people looking for
care how much they'll get, what kind, and when.
That's the way it's done right now across Lake Erie. Yes,
Canada's system covers everyone. That's the goal we're striving
for -- but keep in mind the drawbacks that come with a
nationalized system: the waiting lists for surgery, the limits
on which doctor you see -- the shortages of the high-tech
equipment responsible for so many of the miracles of modern
medicine. // {Let me cite just one example: in all of Canada,
you'll find only 12 M.R.I. machines. There are three right at
the Cleveland Clinic alone.}
And in the end, nationalizing health care pushes costs even
higher. Some studies of Canadian-style plans now circulating in
the Congress estimate the average American family would see its
taxes increase more than $4000 dollars a year. // You get the
3
worst of both worlds: No one has an incentive to control costs -
- and everyone pays. //
Anyone who's spent months checking the mail for that income
tax refund -- or tried to track down a missing social security
check -- or whiled away a day in line at the DMV is going to
think long and hard before they let the government play doctor.
Nationalized health care would be a national disaster. //
But there are other proposals out there, equally harmful.
One's called "Play or pay. Each employer "plays" -- provides
insurance for his employees, or they "pay" -- a payroll tax to
finance government health coverage. This scheme, says its
advocates, gives employers a choice. 11 So does the guy with
the gun in your back when he says: "Your money or your life."
Businessmen and women tell me horror stories about health
care costs spiralling out of control. Well, Play or Pay will
leave a lot of small businesses -- businesses that are on the
edge right now -- with a tough choice: They can cut workers'
wages across the board to pay for mandated health care, they can
fire some workers to cover the rest -- or raise prices, and pass
along the cost to the consumer. Some estimates put the jobs lost
under "Play or Pay" as high as half-a-million or more -- and the
cost to employers at $30 billion / and counting. //
Strip away the rhetoric, and "Play or pay" is really the
back-door route to a nationalized health scheme. It creates
incentives for employers to stop offering benefits, and dumps
millions of workers into Medicaid. And because Play or Pay
4
doesn't pay for itself, the American taxpayer will foot the bill.
In other words, the only sure thing about Play or Pay is pay
/ and pay / and pay. //
Don't look for this analysis from the people pushing Play or
Pay. Ask them about the side-affects of their proposal, and
they'll say: Take two aspirin -- and call me after the election.
The fact is, we don't have to create a new government
bureacracy to give Americans access to affordable, quality health
care. We need a system that delivers -- a system that works for
America -- a system that puts quality care within reach of every
American family.
That system should be built on choice -- not central
control. It should keep costs down -- and open up access. But
above all, it should allow all Americans to rest a little easier
when it comes to health care -- to ease the worry if they change
jobs, or if they or their kids develop serious health problems.
//
My comprehensive five-point plan meets every one of these
common-sense tests. Here's how:
First, we will make health insurance more affordable for
low-to-middle income families. For low-income individuals and
families, I'm proposing a health insurance credit -- up to $3,750
dollars a year to help people purchase private health insurance.
For middle-income individuals and families, I'm urging Congress
to pass a health insurance tax deduction of $3,750. / Every
American family with incomes under $80,000 {-- that's xx% of all
5
American families --} will be eligible for either the credit or
the tax deduction. They'll find health insurance more affordable
-- and they'll be free to choose the plan and the doctors that
serve them best.
Second, we will make health care more efficient. Twenty
years ago, President Nixon pioneered a new idea in health care -
- the HMO. Today, I'm asking you to learn a new acronym: HIN -
- Health Insurance Networks. / Insurance costs are governed by
the "law of large numbers:" The larger the group being insured,
the lower the cost per individual. The idea beind HIN is to
provide incentives for small companies to do what Cleveland's
C.O.S.E. [COZY] group has done -- when it brought 10,000 small
businesses together to make a joint purchase of health care. By
cutting costs, we're going to make health insurance more
affordable -- and more affordable means more accessable.
Third, we will wring out waste and excess in the present
system. We've targetted malpractice for reform. You shouldn't
have to pay a lawyer when you go to the doctor. Right now,
people are doing just that: high malpractice premiums are built
into rising doctors' bills -- and passed along to the American
people. / And I am challenging the health insurance industry to
cut red tape -- to simplify and speed up claims processing.
[Specific challenges.]
Fourth, we will get the growth in federal health programs
under control. Right now, {Medicare} can claim a dubious
distinction: fastest growing program in the federal budget. We
6
won't cut benefits. We won't raise premiums. We can make real
savings simply by cutting the rate of increase. We've set a
target we can reach -- one that will cut the rate of growth from
{10.6% to 9.4%}.
Efficiencies like this will help our reform plan pay for
itself. //
Fifth and finally, we will get information to the people.
We will make everyone a better health care consumer. Right now,
most people pay more attention to the price of toothpaste than
the comparative costs of health care. People don't waste much
time thinking about the costs of their care -- but in the end, we
all pay the price. / We need to follow the lead of initiatives
like Cleveland Health Quality Choice -- programs that give people
"shopping" for health care a kind of "blue book" for medical
costs. Innovations like this one will help all of us keep
overall costs as low as possible.
Providing affordable care, efficient care, / wringing out
excess and waste, controlling federal growth, and getting more
health care cost information into the hands of consumers: these
five points will create the kind of reform that will give
Americans the kind of health care they want and deserve -- and
put an end to the worry that keeps them awake at night.
I keep coming back to what works for this country. When we
talk about health care, we're talking about matters of the most
personal nature -- in some cases, literally, life and death
decisions. We don't need to put government between patients and
7
their doctors. We don't need to create another wasteful federal
bureaucracy. We need common sense, comprehensive health care
reform -- and we need it now. My five-point plan is the right
plan -- a plan that meets our obligation to all Americans by
putting hope and health within their reach. //
Once again, my thanks for this warm Cleveland welcome. May
God bless the United States of America.
# # #
THE WHITE HOUSE
WASHINGTON
FEBRUARY 4, 1992
MEMORANDUM FOR THE PRESIDENT
THROUGH:
DAVE DEMAREST
TONY SNOW IS
FROM:
DAN MC GROARTY mur
SUBJECT:
PROPOSED REMARKS FOR THE ANNUAL MEETING OF THE
GREATER CLEVELAND GROWTH ASSOCIATION
I. SUMMARY
On Thursday, February 6, 1992 at 12:00 p.m. you will deliver
remarks to an audience of 1,500 at the annual meeting of the
Greater Cleveland Growth Association, in the Grand Ballroom of
The Stouffer Tower City Plaza Hotel, Cleveland, Ohio.
II. DISCUSSION
Your remarks (approximately 17 minutes / teleprompter)
announce your comprehensive health care reform plan. The draft
also highlights the alternatives to a market-based health care
system -- Play or Pay and nationalized care -- and their negative
consequences for quality health care.
McGroarty/Bunton
February 4, 1992
5:30 pm
[health]
PRESIDENTIAL REMARKS: GREATER CLEVELAND GROWTH ASSOCIATION
CLEVELAND, OHIO
FEBRUARY 6, 1992
12:00 NOON
[Introductory acknowledgements.] I'm pleased to be back in
Cleveland, capital city of the North Coast. [[opening humor ]]
People who know Northern Ohio know this region's outgrowing
the old rustbelt image. In addition to the world-renowned
Cleveland Clinic -- now the city's number one employer --
Northern Ohio is also home to some of the most innovative
approaches to health care. COSE [COZY] and Cleveland Health
Quality Choice are pioneers: communities across the country can
follow your lead to create workable solutions to health care
challenges. / That's why I've chosen to come to Cleveland this
morning to address the health care crisis -- and lay out my four-
point program for comprehensive health care reform. //
Reform is urgent -- for more reasons than one. / ,Right
now, far too many Americans are uninsured -- and those who are
insured pay too much for health care. And we're going to do'
something about that. //
The one thing this crisis isn't about is quality of care.
American health care is first-rate, the best in the world. And
right now, the vast majority of Americans have access to that
health care system. But the cost has skyrocketed: from $74
billion dollars in 1970 to $800 billion dollars today. And if we
2
keep going at the same rate, that $800 billion will double to
$1.6 trillion by the year 2000.
These numbers alone would make the case for reform. But
cold statistics don't show us the worry people feel -- the all-
too-familiar fear about what happens to their health care if they
change jobs -- or worse still, if they lose their jobs. 11 And
in these hard times, we simply cannot accept the fact that one in
every seven Americans is uninsured. //
There's a better way. / My plan puts the emphasis on
expanding access -- while preserving the choice people now have
over the type of health coverage and health care they receive.
My plan will give Americans a greater sense of security -- help
ease the fears so many Americans have that changing jobs will
cost them their health coverage: the key here is portability --
changing the system to ensure people they'll always have access
to health insurance -- no matter where they go, no matter what.
// Finally, my plan will cut costs. It helps us make héalth
insurance more affordable -- and more affordable means more
accessible.
My plan will preserve what works -- and reform what doesn't.
And above all, it will ensure every American universal access to
affordable health insurance. //
We stand at a crossroads. We can settle on sensible reforms
-- or we can force ourselves to swallow a cure worse than the
disease.
3
Some people have scribbled out a prescription for disaster:
they want to nationalize the health system. Put government in
control of the system: let government control the prices, let
government ration the kind of health care people get -- let
government tell people looking for care how much they'll get,
what kind, and when.
Right now, across Lake Erie, Canada's system covers
everyone. But keep in mind the drawbacks that come with a
nationalized system: long waiting lists for surgery -- shortages
of the high-tech equipment responsible for so many of the
miracles of modern medicine. // Let me cite just one example:
The Cleveland Clinic performs coronary bypass surgeries a
day. Mt. Sinai hospital, which I just visited, does
a day.
High tech, high quality surgery -- without any wait. But if you
live in British Columbia, the wait for coronary bypass surgery is
six months. It's no wonder so many Canadians come to Seattle's
hospitals for surgery.
When you nationalize health care, you push costs higher --
far higher. Some studies estimate that a Canadian-style plan
would cost the average American family a huge new tax burden --
for the nation, a staggering $250 to $500 billion dollars a year
in new taxes. //
Such a massive tax increase is simply unacceptable. //
And for that price, you get the worst of both worlds: No
one has an incentive to control costs -- and everyone pays. //
4
But there are other proposals out there that sound simple,
but are every bit as harmful. One's called "Play or pay. " Each
employer must "play" -- meaning: provide insurance for
employees, or "pay" -- a payroll tax to finance government health
coverage.
Businessmen and women tell me horror stories about health
care costs spiralling out of control. Well, Play or Pay will
leave a lot of small businesses -- businesses struggling on the
edge of survival right now -- with a tough choice: They can cut
workers' wages to pay for mandated health care, they can fire
some workers to cover the rest -- or they can raise prices, and
pass along the cost to the consumer, Some studies put the cost
in jobs lost under "Play or Pay" as high as half-a-million or
more.
Strip away the rhetoric, and "Play or pay" just creates a
back-door route to a nationalized health care. It encourages
employers to stop offering benefits, throw the problem in the
government's lap, and dump millions of fully-insured workers into
a public plan like Medicaid. And because the new employer taxes
in Play or Pay don't pay for the program -- the American taxpayer
will foot the bill. / I'm not about to let that happen. //
You won't hear this from the people pushing Play or Pay.
Ask them about the side-affects of their proposal, and they'll
say: Take two aspirin -- and call me after the election. //
I don't believe people want to be shoveled into some new
health care bureaucracy. They want good health. // A large
5
part of the answer is prevention: every one of us can make
changes in our behavior to reduce the risk of disease and
illness. {Pardon me for being old-fashioned, but what we're
talking about is just plain clean-living -- and there's nothing
wrong with that.} / Tomorrow, in San Diego, I'll focus in more
detail on the ways prevention can help people live healthier
lives -- and help keep our economy healthy, too.
But today, I want to focus on the health care system -- on
my comprehensive, market-based reform plan. / The fact is, we
don't have to create a new government bureaucracy to give
Americans access to affordable, quality health care. We need a
system that delivers -- a system that works for America -- a
system that puts quality care within reach of every American
family.
Our system should be built on choice -- not central control.
It should keep costs down -- and open up access. But above all,
it should allow all Americans to rest secure when it comes to
health care -- to ease their worry that if they change jobs, if
they or their kids develop serious health problems, they'll still
be able to count on the coverage they need. //
My comprehensive four-point plan meets every one of these
common-sense tests. Here's how:
Point one: we will make health care more accessible by
making health insurance more affordable. For low-income
individuals and families, I propose a health insurance credit --
up to $3,750 dollars a year to guarantee people, even people too
6
poor to file taxes, the ability to purchase private health
insurance. That will put in their hands a certificate or voucher
worth more than $300 dollars a month. They can use it to buy
into the plan their employers offer but they could never afford -
- or they can shop for whatever private plan suits them best.
That's the American commitment to choice at its best.
For middle-income individuals and families, I propose a
health insurance tax deduction of $3,750. / American families
with incomes under $80,000 will receive new help from either the
credit or the tax deduction. Let me tell you what that means:
new help to purchase health insurance for 95 million Americans.
Once again, this insurance will be portable: people who
change jobs would have insurance regardless of their health --
and this is important -- or their family's health.
But best of all, my plan will bring health care coverage to
30 million uninsured Americans -- security / to people who for
far too long have had to do without. //
That's the first point in my four-point plan: access.
Point two: we will cut the runaway costs of health care by
making the system more efficient. Today, I'm asking you to learn
a new acronym: HIN -- Health Insurance Networks. / Insurance
costs obey the "law of large numbers:" The larger the group
being insured, the lower the cost per individual. "Pooling"
lowers insurance costs -- and significantly cuts administrative
costs. HIN's will provide incentives for small companies to do
what Cleveland's C.O.S.E. [COZY] group has done -- when it
7
brought 10,000 small businesses together to make a joint purchase
of health care.
Another way to drive costs down: make everyone a better
health care consumer. Right now, most people pay more attention
to the price of toothpaste than the comparative costs of health
care. People don't waste much time thinking about the costs of
their care -- but in the end, we all pay the price. We need to
follow the lead of initiatives like Cleveland Health Quality
Choice -- programs that give people "shopping" for health care a
kind of "blue book" for medical costs. // Innovations like
these will help all of us keep the costs of quality health care
as low as possible.
Point Three: we will wring out waste and excess in the
present system. We've targeted medical malpractice for reform.
It's time to put an end to these astronomical, sky's-the-limit
lawsuits. // You shouldn't have to pay a lawyer when you go to
the doctor. / /
Right now, people do just that: high malpractice premiums
mean higher doctors' bills, higher hospital costs -- costs passed
along to the patient. / I have challenged the health insurance
industry to cut red tape -- to share common forms, and to
simplify and speed up claims processing. Here's a challenge for
the next four years: There is no reason almost all health
insurance claims can't be processed electronically. That single
step would eliminate a mountain of health care paperwork and pare
back costs.
8
Fourth and finally, we will get the growth in federal health
programs under control. Right now, government health care
programs can claim a dubious distinction: they are the fastest
growing parts in the federal budget. / We must bring runaway
costs under control. We won't cut benefits -- we can make real
savings simply by reducing the rate of increase.
Efficiencies like this will help our reform plan pay for
itself. //
The federal government should also give states the
flexibility to design new universal access programs for the poor
-- programs that will provide quality services to all their
citizens. I've just met with the Governors -- they want
flexibility, and we'll give it to them. States will be able to
use new federal resources to design programs that work -- not
one-size-fits-all solutions imposed by Washington.
Providing affordable care, efficient care, / wringing out
excess and waste and controlling federal growth: these four
points will create the kind of market-based reform plan that will
give Americans the kind of health care they want and deserve --
and put an end to the worry that keeps them awake at night.
Remember what people want. People want quality care / care
they can afford / care they can count on.
I keep coming back to what works for this country. //
We've got to make certain our reform corrects our weaknesses
without destroying our strengths. / When we talk about health
care, we're talking about matters of the most personal nature --
9
in some cases, literally, life and death decisions. We don't
need to put government between patients and their doctors. We
don't need to create another wasteful federal bureaucracy. This
President won't let that happen. //
We need common sense, comprehensive health care reform --
and we need it now. My plan is the right plan -- a plan that
meets our obligation to all Americans by putting hope and health
within their reach. //
Once again, my thanks for this warm Cleveland welcome. May
God bless the United States of America.
# # #
THE WHITE HOUSE
WASHINGTON
FEBRUARY 4, 1992
MEMORANDUM FOR THE PRESIDENT
THROUGH:
DAVE DEMAREST
TONY SNOW TS
FROM:
DAN MC GROARTY mur
SUBJECT:
PROPOSED REMARKS FOR THE ANNUAL MEETING OF THE
GREATER CLEVELAND GROWTH ASSOCIATION
I. SUMMARY
On Thursday, February 6, 1992 at 12:00 p.m. you will deliver
remarks to an audience of 1,500 át the annual meeting of the
Greater Cleveland Growth Association, in the Grand Ballroom of
The Stouffer Tower City Plaza Hotel, Cleveland, Ohio.
II. DISCUSSION
Your remarks (approximately 17 minutes / teleprompter)
announce your comprehensive health care reform plan. The draft
also highlights the alternatives to a market-based health care
system -- Play or Pay and nationalized care -- and their negative
consequences for quality health care.
McGroarty/Bunton
February 4, 1992
5:30 pm
[health]
PRESIDENTIAL REMARKS: GREATER CLEVELAND GROWTH ASSOCIATION
CLEVELAND, OHIO
FEBRUARY 6, 1992
12:00 NOON
[Introductory acknowledgements.] I'm pleased to be back in
Cleveland, capital city of the North Coast. [[opening humor. ]]
People who know Northern Ohio know this region's outgrowing
the old rustbelt image. In addition to the world-renowned
Cleveland Clinic -- now the city's number one employer --
Northern Ohio is also home to some of the most innovative
approaches to health care. COSE [COZY] and Cleveland Health
Quality Choice are pioneers: communities across the country can
follow your lead to create workable solutions to health care
challenges. / That's why I've chosen to come to Cleveland this
morning to address the health care crisis -- and lay out my four-
point program for comprehensive health care reform. //
Reform is urgent -- for more reasons than one. / Right
now, far too many Americans are uninsured -- and those who are
insured pay too much for health care. And we're going to do
something about that. //
The one thing this crisis isn't about is quality of care.
American health care is first-rate, the best in the world. And
right now, the vast majority of Americans have access to that
health care system. But the cost has skyrocketed: from $74
billion dollars in 1970 to $800 billion dollars today. And if we
2
keep going at the same rate, that $800 billion will double to
$1.6 trillion by the year 2000.
These numbers alone would make the case for reform. But
cold statistics don't show us the worry people feel -- the all-
too-familiar fear about what happens to their health care if they
change jobs -- or worse still, if they lose their jobs. // And
in these hard times, we simply cannot accept the fact that one in
every seven Americans is uninsured. //
There's a better way. / My plan puts the emphasis on
expanding access -- while preserving the choice people now have
over the type of health coverage and health care they receive.
My plan will give Americans a greater sense of security -- help
ease the fears so many Americans have that changing jobs will
cost them their health coverage: the key here is portability --
changing the system to ensure people they'll always have access
to health insurance -- no matter where they go, no matter what.
// Finally, my plan will cut costs. It helps us make health
insurance more affordable -- and more affordable means more
accessible.
My plan will preserve what works -- and reform what doesn't.
And above all, it will ensure every American universal access to
affordable health insurance.
//
We stand at a crossroads. We can settle on sensible reforms
-- or we can force ourselves to swallow a cure worse than the
disease.
3
Some people have scribbled out a prescription for disaster:
they want to nationalize the health system. Put government in
control of the system: let government control the prices, let
government ration the kind of health care people get -- let
government tell people looking for care how much they'll get,
what kind, and when.
Right now, across Lake Erie, Canada's system covers
everyone. But keep in mind the drawbacks that come with a
nationalized system: long waiting lists for surgery -- shortages
of the high-tech equipment responsible for so many of the
miracles of modern medicine. // Let me cite just one example:
The Cleveland Clinic performs coronary bypass surgeries a
day. Mt. Sinai hospital, which I just visited, does
a day.
High tech, high quality surgery -- without any wait. But if you
live in British Columbia, the wait for coronary bypass surgery is
six months. It's no wonder so many Canadians come to Seattle's
hospitals for surgery.
When you nationalize health care, you push costs higher --
far higher. Some studies estimate that a Canadian-style plan
would cost the average American family a huge new tax burden --
for the nation, a staggering $250 to $500 billion dollars a year
in new taxes. //
Such a massive tax increase is simply unacceptable. //
And for that price, you get the worst of both worlds: No
one has an incentive to control costs -- and everyone pays. //
4
But there are other proposals out there that sound simple,
but are every bit as harmful. One's called "Play or pay. Each
employer must "play" -- meaning: provide insurance for
employees, or "pay" -- a payroll tax to finance government health
coverage.
Businessmen and women tell me horror stories about health
care costs spiralling out of control. Well, Play or Pay will
leave a lot of small businesses -- businesses struggling on the
edge of survival right now -- with a tough choice: They can cut
workers' wages to pay for mandated health care, they can fire
some workers to cover the rest -- or they can raise prices, and
pass along the cost to the consumer. Some studies put the cost
in jobs lost under "Play or Pay" as high as half-a-million or
more.
Strip away the rhetoric, and "Play or pay" just creates a
back-door route to a nationalized health care. It encourages
employers to stop offering benefits, throw the problem in the
government's lap, and dump millions of fully-insured workers into
a public plan like Medicaid. And because the new employer taxes
in Play or Pay don't pay for the program -- the American taxpayer
will foot the bill. / I'm not about to let that happen. //
You won't hear this from the people pushing Play or Pay.
Ask them about the side-affects of their proposal, and they'll
say: Take two aspirin -- and call me after the election. //
I don't believe people want to be shoveled into some new
health care bureaucracy. They want good health. // A large
5
part of the answer is prevention: every one of us can make
changes in our behavior to reduce the risk of disease and
illness. {Pardon me for being old-fashioned, but what we're
talking about is just plain clean-living -- and there's nothing
wrong with that.} / Tomorrow, in San Diego, I'll focus in more
detail on the ways prevention can help people live healthier
lives -- and help keep our economy healthy, too.
But today, I want to focus on the health care system -- on
my comprehensive, market-based reform plan. / The fact is, we
don't have to create a new government bureaucracy to give
Americans access to affordable, quality health care. We need a
system that delivers -- a system that works for America -- a
system that puts quality care within reach of every American
family.
Our system should be built on choice -- not central control.
It should keep costs down -- and open up access. But above all,
it should allow all Americans to rest secure when it comes to
health care -- to ease their worry that if they change jobs, if
they or their kids develop serious health problems, they'll still
be able to count on the coverage they need. //
My comprehensive four-point plan meets every one of these
common-sense tests. Here's how:
Point one: we will make health care more accessible by
making health insurance more affordable. For low-income
individuals and families, I propose a health insurance credit --
up to $3,750 dollars a year to guarantee people, even people too
1
6
poor to file taxes, the ability to purchase private health
insurance. That will put in their hands a certificate or voucher
worth more than $300 dollars a month. They can use it to buy
into the plan their employers offer but they could never afford -
- or they can shop for whatever private plan suits them best.
That's the American commitment to choice at its best.
For middle-income individuals and families, I propose a
health insurance tax deduction of $3,750. / American families
with incomes under $80,000 will receive new help from either the
credit or the tax deduction. Let me tell you what that means:
new help to purchase health insurance for 95 million Americans.
Once again, this insurance will be portable: people who
change jobs would have insurance regardless of their health --
and this is important -- or their family's health.
But best of all, my plan will bring health care coverage to
30 million uninsured Americans -- security / to people who for
far too long have had to do without. //
That's the first point in my four-point plan: access.
Point two: we will cut the runaway costs of health care by
making the system more efficient. Today, I'm asking you to learn
a new acronym: HIN -- Health Insurance Networks. / Insurance
costs obey the "law of large numbers:" The larger the group
being insured, the lower the cost per individual. "Pooling"
lowers insurance costs -- and significantly cuts administrative
costs. HIN's will provide incentives for small companies to do
what Cleveland's C.O.S.E. [COZY] group has done -- when it
)
7
brought 10,000 small businesses together to make a joint purchase
of health care.
Another way to drive costs down: make everyone a better
health care consumer. Right now, most people pay more attention
to the price of toothpaste than the comparative costs of health
care. People don't waste much time thinking about the costs of
their care -- but in the end, we all pay the price. We need to
follow the lead of initiatives like Cleveland Health Quality
Choice -- programs that give people "shopping" for health care a
kind of "blue book" for medical costs. // Innovations like
these will help all of us keep the costs of quality health care
as low as possible.
Point Three: we will wring out waste and excess in the
present system. We've targeted medical malpractice for reform.
It's time to put an end to these astronomical, sky's-the-limit
lawsuits. // You shouldn't have to pay a lawyer when you go to
the doctor. //
Right now, people do just that: high malpractice premiums
mean higher doctors' bills, higher hospital costs -- costs passed
along to the patient. / I have challenged the health insurance
industry to cut red tape -- to share common forms, and to
simplify and speed up claims processing. Here's a challenge for
the next four years: There is no reason almost all health
insurance claims can't be processed electronically. That single
step would eliminate a mountain of health care paperwork and pare
back costs.
8
Fourth and finally, we will get the growth in federal health
programs under control. Right now, government health care
programs can claim a dubious distinction: they are the fastest
growing parts in the federal budget. / We must bring runaway
costs under control. We won't cut benefits -- we can make real
savings simply by reducing the rate of increase.
Efficiencies like this will help our reform plan pay for
itself. //
The federal government should also give states the
flexibility to design new universal access programs for the poor
-- programs that will provide quality services to all their
citizens. I've just met with the Governors -- they want
flexibility, and we'll give it to them. States will be able to
use new federal resources to design programs that work -- not
one-size-fits-all solutions imposed by Washington.
Providing affordable care, efficient care, / wringing out
excess and waste and controlling federal growth: these four
points will create the kind of market-based reform plan that will
give Americans the kind of health care they want and deserve --
and put an end to the worry that keeps them awake at night.
Remember what people want. People want quality care / care
they can afford / care they can count on.
I keep coming back to what works for this country. //
We've got to make certain our reform corrects our weaknesses
without destroying our strengths. / When we talk about health
care, we're talking about matters of the most personal nature --
9
in some cases, literally, life and death decisions. We don't
need to put government between patients and their doctors. We
don't need to create another wasteful federal bureaucracy. This
President won't let that happen. //
We need common sense, comprehensive health care reform --
and we need it now. My plan is the right plan -- a plan that
meets our obligation to all Americans by putting hope and health
within their reach. //
Once again, my thanks for this warm Cleveland welcome. May
God bless the United States of America.
# # #
THE WHITE HOUSE
WASHINGTON
92 JAN 4 P2: 49
February 3, 1992
MEMORANDUM FOR TONY SNOW
Deputy Assistant to the President for
Communications and Director of Speechwriting
FROM:
JANET REHNQUIST JR
Associate Counsel to the President
SUBJECT:
Presidential Remarks -- Greater Cleveland Growth
Association; Cleveland, Ohio; February 6, 1992
This is in follow-up to my telephone call to your office today
regarding the above-referenced matter. Counsel's Office has no
legal objections.
Thank you for the opportunity to review this matter.
CC: Phil Brady
Document No. 304159ss
WHITE HOUSE STAFFING MEMORANDUM
DATE. 2/4/92
ACTION/CONCURRENCE/COMMENT DUE BY:
---
PRESIDENTIAL REMARKS: ANNUAL MEETING OF THE GREATER CLEVELAND
SUBJECT: GROWTH ASSOCIATION - - THURSDAY, FEB. 6 - 2:00 PM
ACTION FYI
ACTION FYI
1
VICE PRESIDENT
HORNER
1
SKINNER
1
CALIO
SCOWCROFT
PETERSMEYER
1
DARMAN
PORTER
1
BRADY
1
ROGICH
1
BROMLEY
1
SMITH
1
CARD
BOSKIN
1
1
KAUFMAN
DEMAREST
1
FITZWATER
FINDLAY
-
GRAY
SNOW
HOLIDAY
REMARKS:
The attached has been forwarded to the President.
RESPONSE:
PHILLIP D. BRADY
Assistant to the President
and Staff Secretary
Ext. 2702
THE WHITE HOUSE
WASHINGTON
02 FEB 4 P6:21
FEBRUARY 4, 1992
MEMORANDUM FOR THE PRESIDENT
THROUGH:
DAVE DEMAREST
TONY SNOW. TS
FROM:
DAN MC GROARTY mur
SUBJECT:
PROPOSED REMARKS FOR THE ANNUAL MEETING OF THE a
GREATER CLEVELAND GROWTH ASSOCIATION
I. SUMMARY
On Thursday, February 6, 1992 at 12:00 p.m. you will deliver
remarks to an audience of 1,500 at the annual meeting of the
Greater Cleveland Growth Association, in the Grand Ballroom of
The Stouffer Tower City Plaza Hotel, Cleveland, Ohio.
II. DISCUSSION
Your remarks (approximately 17 minutes / teleprompter)
announce your comprehensive health care reform plan. The draft
also highlights the alternatives to a market-based health care
system -- Play or Pay and nationalized care -- and their negative
consequences for quality health care.
McGroarty/Bunton
February 4, 1992
5:30 pm
[health]
PRESIDENTIAL REMARKS: GREATER CLEVELAND GROWTH ASSOCIATION
CLEVELAND, OHIO
FEBRUARY 6, 1992
12:00 NOON
[Introductory acknowledgements.] I'm pleased to be back in
Cleveland, capital city of the North Coast. [[opening humor...]]
People who know Northern Ohio know this region's outgrowing
the old rustbelt image. In addition to the world-renowned
Cleveland Clinic -- now the city's number one employer --
Northern Ohio is also home to some of the most innovative
approaches to health care. COSE [COZY] and Cleveland Health
Quality Choice are pioneers: communities across the country can
follow your lead to create workable solutions to health care
challenges. / That's why I've chosen to come to Cleveland this
morning to address the health care crisis -- and lay out my four-
point program for comprehensive health care reform. //
Reform is urgent -- for more reasons than one. / ,Right
now, far too many Americans are uninsured -- and those who are
insured pay too much for health care. And we're going to do.
something about that. //
The one thing this crisis isn't about is quality of care.
American health care is first-rate, the best in the world. And
right now, the vast majority of Americans have access to that
health care system. But the cost has skyrocketed: from $74
billion dollars in 1970 to $800 billion dollars today. And if we
2
keep going at the same rate, that $800 billion will double to
$1.6 trillion by the year 2000.
These numbers alone would make the case for reform. But
cold statistics don't show us the worry people feel -- the all-
too-familiar fear about what happens to their health care if they
change jobs -- or worse still, if they lose their jobs. // And
in these hard times, we simply cannot accept the fact that one in
every seven Americans is uninsured. //
There's a better way. / My plan puts the emphasis on
expanding access -- while preserving the choice people now have
over the type of health coverage and health care they receive.
My plan will give Americans a greater sense of security -- help
ease the fears so many Americans have that changing jobs will
cost them their health coverage: the key here is portability --
changing the system to ensure people they'll always have access
to health insurance -- no matter where they go, no matter what.
// Finally, my plan will cut costs. It helps us make héalth
insurance more affordable -- and more affordable means more
accessible.
My plan will preserve what works -- and reform what doesn't.
And above all, it will ensure every American universal access to
affordable health insurance. //
We stand at a crossroads. We can settle on sensible reforms
-- or we can force ourselves to swallow a cure worse than the
disease.
3
Some people have scribbled out a prescription for disaster:
they want to nationalize the health system. Put government in
control of the system: let government control the prices, let
government ration the kind of health care people get -- let
government tell people looking for care how much they'll get,
what kind, and when.
Right now, across Lake Erie, Canada's system covers
everyone. But keep in mind the drawbacks that come with a
nationalized system: long waiting lists for surgery -- shortages
of the high-tech equipment responsible for so many of the
miracles of modern medicine. // Let me cite just one example:
The Cleveland Clinic performs
coronary bypass surgeries a
day. Mt. Sinai hospital, which I just visited, does
a day.
High tech, high quality surgery -- without any wait. But if you
live in British Columbia, the wait for coronary bypass surgery is
six months. It's no wonder so many Canadians come to Seattle's
hospitals for surgery.
When you nationalize health care, you push costs higher --
far higher. Some studies estimate that a Canadian-style plan
would cost the average American family a huge new tax burden --
for the nation, a staggering $250 to $500 billion dollars a year
in new taxes. //
Such a massive tax increase is simply unacceptable. //
And for that price, you get the worst of both worlds: No
one has an incentive to control costs -- and everyone pays. //
4
But there are other proposals out there that sound simple,
but are every bit as harmful. One's called "Play or pay. " Each
employer must "play" -- meaning: provide insurance for
employees, or "pay" -- a payroll tax to finance government health
coverage.
Businessmen and women tell me horror stories about health
care costs spiralling out of control. Well, Play or Pay will
leave a lot of small businesses -- businesses struggling on the
edge of survival right now -- with a tough choice: They can cut
workers' wages to pay for mandated health care, they can fire
some workers to cover the rest -- or they can raise prices, and
pass along the cost to the consumer. Some studies put the cost
in jobs lost under "Play or Pay" as high as half-a-million or
more.
Strip away the rhetoric, and "Play or pay" just creates a
back-door route to a nationalized health care. It encourages
employers to stop offering benefits, throw the problem in the
government's lap, and dump millions of fully-insured workers into
a public plan like Medicaid. And because the new employer taxes
in Play or Pay don't pay for the program -- the American taxpayer
will foot the bill. / I'm not about to let that happen. //
You won't hear this from the people pushing Play or Pay.
Ask them about the side-affects of their proposal, and they'll
say: Take two aspirin -- and call me after the election. //
I don't believe people want to be shoveled into some new
health care bureaucracy. They want good health. // A large
5
part of the answer is prevention: every one of us can make
changes in our behavior to reduce the risk of disease and
illness. {Pardon me for being old-fashioned, but what we're
talking about is just plain clean-living -- and there's nothing
wrong with that.} / Tomorrow, in San Diego, I'll focus in more
detail on the ways prevention can help people live healthier
lives -- and help keep our economy healthy, too.
But today, I want to focus on the health care system -- on
my comprehensive, market-based reform plan. / The fact is, we
don't have to create a new government bureaucracy to give
Americans access to affordable, quality health care. We need a
system that delivers -- a system that works for America -- a
system that puts quality care within reach of every American
family.
Our system should be built on choice -- not central control.
It should keep costs down -- and open up access. But above all,
it should allow all Americans to rest secure when it comes to
health care -- to ease their worry that if they change jobs, if
they or their kids develop serious health problems, they'll still
be able to count on the coverage they need. //
My comprehensive four-point plan meets every one of these
common-sense tests. Here's how:
Point one: we will make health care more accessible by
making health insurance more affordable. For low-income
individuals and families, I propose a health insurance credit --
up to $3,750 dollars a year to guarantee people, even people too
6
poor to file taxes, the ability to purchase private health
insurance. That will put in their hands a certificate or voucher
worth more than $300 dollars a month. They can use it to buy
into the plan their employers offer but they could never afford -
- or they can shop for whatever private plan suits them best.
That's the American commitment to choice at its best.
For middle-income individuals and families, I propose a
health insurance tax deduction of $3,750. / American families
with incomes under $80,000 will receive new help from either the
credit or the tax deduction. Let me tell you what that means:
new help to purchase health insurance for 95 million Americans.
Once again, this insurance will be portable: people who
change jobs would have insurance regardless of their health --
and this is important -- or their family's health.
But best of all, my plan will bring health care coverage to
30 million uninsured Americans -- security / to people who for
far too long have had to do without. //
That's the first point in my four-point plan: access.
Point two: we will cut the runaway costs of health care by
making the system more efficient. Today, I'm asking you to learn
a new acronym: HIN -- Health Insurance Networks. / Insurance
costs obey the "law of large numbers:" The larger the group
being insured, the lower the cost per individual. "Pooling"
lowers insurance costs -- and significantly cuts administrative
costs. HIN's will provide incentives for small companies to do
what Cleveland's C.O.S.E. [COZY] group has done -- when it
7
brought 10,000 small businesses together to make a joint purchase
of health care.
Another way to drive costs down: make everyone a better
health care consumer. Right now, most people pay more attention
to the price of toothpaste than the comparative costs of health
care. People don't waste much time thinking about the costs of
their care -- but in the end, we all pay the price. We need to
follow the lead of initiatives like Cleveland Health Quality
Choice -- programs that give people "shopping" for health care a
kind of "blue book" for medical costs. // Innovations like
these will help all of us keep the costs of quality health care
as low as possible.
Point Three: we will wring out waste and excess in the
present system. We've targeted medical malpractice for reform.
It's time to put an end to these astronomical, sky's-the-limit
lawsuits. // You shouldn't have to pay a lawyer when you go to
the doctor. 11
Right now, people do just that: high malpractice premiums
mean higher doctors' bills, higher hospital costs -- costs passed
along to the patient. / I have challenged the health insurance
industry to cut red tape -- to share common forms, and to
simplify and speed up claims processing. Here's a challenge for
the next four years: There is no reason almost all health
insurance claims can't be processed electronically. That single
step would eliminate a mountain of health care paperwork and pare
back costs.
8
Fourth and finally, we will get the growth in federal health
programs under control. Right now, government health care
programs can claim a dubious distinction: they are the fastest
growing parts in the federal budget. / We must bring runaway
costs under control. We won't cut benefits -- we can make real
savings simply by reducing the rate of increase.
Efficiencies like this will help our reform plan pay for
itself. //
The federal government should also give states the
flexibility to design new universal access programs for the poor
-- programs that will provide quality services to all their
citizens. I've just met with the Governors -- they want
flexibility, and we'll give it to them. States will be able to
use new federal resources to design programs that work -- not
one-size-fits-all solutions imposed by Washington.
Providing affordable care, efficient care, / wringing out
excess and waste and controlling federal growth: these four
points will create the kind of market-based reform plan that will
give Americans the kind of health care they want and deserve --
and put an end to the worry that keeps them awake at night.
Remember what people want. People want quality care / care
they can afford / care they can count on.
I keep coming back to what works for this country. //
We've got to make certain our reform corrects our weaknesses
without destroying our strengths. / When we talk about health
care, we're talking about matters of the most personal nature --
9
in some cases, literally, life and death decisions. We don't
need to put government between patients and their doctors. We
don't need to create another wasteful federal bureaucracy. This
President won't let that happen. //
We need common sense, comprehensive health care reform --
and we need it now. My plan is the right plan -- a plan that
meets our obligation to all Americans by putting hope and health
within their reach. //
Once again, my thanks for this warm Cleveland welcome. May
God bless the United States of America.
# # #
McGroarty/Bunton
February 5, 1992
5:30 pm
[health]
PRESIDENTIAL REMARKS: GREATER CLEVELAND GROWTH ASSOCIATION
CLEVELAND, OHIO
FEBRUARY 6, 1992
12:20 P.M.
[Introductory acknowledgements.] I'm pleased to be back in
Cleveland, capital city of the North Coast. Hello to Bob Horton,
head of BP {British Petroleum}, a man committed to this great
city. My good. friend, Governor George Voinovich -- and Lt. Gov.
Mike DeWine: a team that's providing top-notch leadership for
this state. Joe Gorman of TRW, who travelled with me early this
year to East Asia. // Good things are happening here -- for the
Cleveland Cavs: a great season. [[In fact, I told the Governor
I was going to be speaking today about the number one health
issue on every Clevelander's mind, and he said: Mr. President -
- Mark Price's left knee is just fine. //]]
People who know Northern Ohio know this region's on the
move. In addition to the world-renowned Cleveland Clinic -- now
the city's number one employer -- Northern Ohio is also home to
some of the most innovative approaches to health care. COSE
[COZY] and Cleveland Health Quality Choice are pioneers:
communities across the country can follow your lead to create
workable solutions to health care challenges. / That's why I've
chosen to come to Cleveland this morning to address the health
care crisis -- and lay out my four-point program for
comprehensive health care reform. //
i
2
Reform is urgent -- for more reasons than one. / Right
now, far too many Americans are uninsured -- and those who are
insured pay too much for health care. And we're going to do
something about that. //
The one thing this crisis isn't about is quality of care.
American health care is first-rate, the best in the world. And
right now, the vast majority of Americans have access to that
health care system. But the cost has skyrocketed: from $74
billion dollars in 1970 to $800 billion dollars today. And if we
keep going at the same rate, that $800 billion will double to
$1.6 trillion by the year 2000.
These numbers alone would make the case for reform. They
tell us there's a connection we simply can't ignore between what
we pay for health care and the long-term health of our economy.
But cold statistics don't show us the worry people feel -- the
all-too-familiar fear about what happens to their health care if
they change jobs -- or worse still, if they lose their jobs. //
And in these hard times, we simply cannot accept the fact that
one in every seven Americans is uninsured. //
There's a better way. / My plan puts the emphasis on
expanding access -- while preserving the choice people now have
over the type of health coverage and health care they receive.
My plan will give Americans a greater sense of security -- help
ease the fears so many Americans have that changing jobs will
cost them their health coverage: the key here is portability --
changing the system to ensure people they'll always have access
3
to health insurance -- no matter where they work. // Finally,
my plan will cut costs. It helps us make health insurance more
affordable -- and more affordable means more accessible.
My plan will preserve what works -- and reform what doesn't.
And above all, it will ensure every American universal access to
affordable health insurance. //
We stand at a crossroads. We can move forward to
dramatically reform our market-based system -- or we can force
ourselves to swallow a cure worse than the disease.
Some people have scribbled out a prescription for disaster:
they want to nationalize the health system. Put government in
control of the system: let government control the prices, let
government ration the kind of health care people get -- let
government tell people looking for care how much they'll get,
what kind, and when.
Nationalized systems cover everyone. But keep in mind the
drawbacks that come with a nationalized system: long waiting
lists for surgery -- shortages of the high-tech equipment
responsible for so many of the miracles of modern medicine. //
Let me cite just one example: The Cleveland Clinic performs 10
coronary bypass surgeries a day. High tech, high quality surgery
-- without any wait. But if you live in British Columbia, the
wait for coronary bypass surgery is six months. It's no wonder
so many people from abroad come to American hospitals for
surgery.
5
back off? Because the signals were clear. They knew that
businesses -- small businesses mainly -- would pack up and leave
Massachusetts, or go out of business because they couldn't bear
the additional expense. ]]
Strip away the rhetoric, and "Play or pay" just creates a
back-door route to a nationalized health care. It encourages
employers to stop offering benefits, throw the problem in the
government's lap, and dump millions of fully-insured workers into
a public plan like Medicaid. And because the new employer taxes
in Play or Pay don't pay for the program -- the American taxpayer
will foot the bill. / I'm not about to let that happen. //
You won't hear this from the people pushing Play or Pay.
Ask them about the side-affects of their proposal, and they'll
say: Take two aspirin -- and call me after the election. //
I don't believe people want to be shoveled into some new
health care bureaucracy. They want good health. // A large
part of the answer is prevention: every one of us can make
changes in our behavior to reduce the risk of disease and
illness. {Pardon me for being old-fashioned, but what we're
talking about is behavior, life-style -- you know what I'm
talking about -- and there's nothing wrong with that. } /
Tomorrow, in San Diego, I'll focus in more detail on the ways
prevention can help people live healthier lives -- and help keep
our economy healthy, too.
But today, I want to focus on the health care system -- on
my comprehensive, market-based reform plan. / The fact is, we
Look at Billy and Hillay Clinton.
Read my Lips: No new sex.
6
don't have to create a new government bureaucracy to give
Americans access to affordable, quality health care. We need a
system that delivers -- a system that works for America -- a
system that puts quality care within reach of every American
family.
Our system should be built on choice -- not central control.
It should keep costs down -- and open up access. But above all,
it should allow all Americans to rest secure when it comes to
health care -- to ease their worry that if they change jobs, if
they or their kids develop serious health problems, they'll still
be able to count on the coverage they need. //
My comprehensive four-point plan meets every one of these
common-sense tests. Here's how:
Point one: we will make health care more accessible by
making health insurance more affordable. For low-income
individuals and families, I propose a health insurance credit --
up to $3,750 dollars a year to guarantee people, even people too
poor to file taxes, the ability to purchase private health
insurance. That will give these families a certificate or
voucher to be used strictly for health care worth more than $300
dollars a month. They can use it to buy into the plan their
employers offer but they could never afford -- or they can shop
for whatever private plan suits them best.
That's the American commitment to choice at its best.
For middle-income individuals and families, I propose a
health insurance tax deduction of $3,750. / American families
7
with incomes under $80,000 will receive new help from either the
credit or the tax deduction. Let me tell you what that means:
new help to purchase health insurance for 95 million Americans.
Once again, this insurance will be portable: people who
change jobs would have insurance regardless of their health --
and this is important -- or their family's health.
But best of all, my plan will bring health care coverage to
almost 30 million uninsured Americans -- security / to people who
-- for far too long -- have had to do without. ///
That's the first point in my four-point plan: access.
Point two: we will cut the runaway costs of health care by
making the system more efficient. Today, I'm asking you to learn
a new acronym: HIN -- Health Insurance Networks. / Insurance
costs obey the "law of large numbers:" The larger the group
being insured, the lower the cost per individual. "Pooling"
lowers insurance costs -- and significantly cuts administrative
costs. Administrative costs for large companies can eat up 5 to
10 percent of revenues -- for small companies, the cost can be
four times as high. / HIN's will provide incentives for small
companies to do what Cleveland's C.O.S.E. [COZY] group has done -
- when it brought 10,000 small businesses together to make a
joint purchase of health care.
Another way to drive costs down: make everyone a better
health care consumer. Right now, most people pay more attention
to the price of toothpaste than the comparative costs of health
care. People don't waste much time thinking about the costs of
8
their care -- but in the end, we all pay the price. We need to
follow the lead of initiatives like Cleveland Health Quality
Choice -- programs that give people "shopping" for health care a
kind of "blue book" for medical costs. // Innovations like
these will help all of us keep the costs of quality health care
as low as possible.
Point Three: we will wring out waste and excess in the
present system. We've targeted medical malpractice for reform.
It's time to put an end to these astronomical, sky's-the-limit
lawsuits. // You shouldn't have to pay a lawyer when you go to
the doctor. // And our doctors -- the most able and dedicated
in the world -- shouldn't be living in fear of these outrageous
lawsuits. //
High malpractice premiums mean higher doctors' bills, higher
hospital costs -- costs passed along not only to the patient, but
to every American taxpayer. /
I have challenged the health insurance industry to cut red
tape -- to share common forms, and to simplify and speed up
claims processing. Here's a challenge for the next four years:
There is no reason almost all health insurance claims can't be
processed electronically. That single step would eliminate a
mountain of health care paperwork and pare back costs.
when
[[ We've got to attack the excesses of mandated benefits.
States now order health insurers to cover a thousand different
types of treatment Something's gone wrong. Next, they' 11 be
covering manicures for my dog Millie. ]]
9
Fourth and finally, we will get the growth in federal health
programs under control. Right now, government health care
programs can claim a dubious distinction: they are the fastest
growing parts in the federal budget. This year alone, Medicaid
not repeat not
costs will increase by 38 percent.
We won't cut benefits
we can make real savings simply by reducing thsi huge rate of
benefit
increase. / We must bring runaway costs under control.
R
Efficiencies like this will help our reform plan pay for
itself. //
The federal government should also give states the
flexibility to design new universal access programs for the poor
-- programs that will provide quality services to all their
citizens. I've just met with the Governors -- they want
flexibility, and we'll give it to them. Right here in Ohio,
Governor Voinovich has proposed health care reforms that will do
for this state what we want to do on the federal level.
/
States should be able to use new federal resources to design
programs that work -- not one-size-fits-all solutions imposed by
Washington.
Providing affordable care, efficient care, / wringing out
excess and waste and controlling federal growth: these four
points will create the kind of market-based reform plan that will
give Americans the kind of health care they want and deserve --
and put an end to the worry that keeps them awake at night.
Remember what people want. People want quality care / care
they can afford / care they can count on.
10
I keep coming back to what works for this country. //
Think about the challenges we face as a nation: anyone who
concerned about competitiveness has to see controlling health
care costs as key to a healthy economy. / We've got to make
certain our reform corrects our weaknesses without destroying our
strengths. / When we talk about health care, we're talking
about matters of the most personal nature -- in some cases,
literally, life and death decisions. We don't need to put
government between patients and their doctors. We don't need to
create another wasteful federal bureaucracy. This President
won't let that happen. //
We need common sense, comprehensive health care reform --
and we need it now. My plan is the right plan -- a plan that
meets our obligation to all Americans by putting hope and health
within their reach. //
Once again, my thanks for this warm Cleveland welcome. May
God bless the United States of America.
# # #
628-0640
6636
Dam
shaton 23
WHITE HOUSE STAFFING REQUEST
Presidential Remarks: Subject Greater
Date/Time Received:
2/3 3:45Pm
RESPONSE DUE: Today 4:30P.M. 2/3
Response due to Director's Office Support Group, Room 254, Ext. 3060.
Please respond to every staffing request, even if you have no comment.
Distribution Within OMB
Action
FYI
Action
FYI
Director
Howard, R.
Deputy Director
Legis. Affairs
Dep. Dir./Mgmt.
Lieberman, S.
MacRae, J.
I
Al-Samarrie, A.
Martin, B.
-
Anderson, B.
Mazur, E.
Burman, A.
Murr, J.
Dale, E.
Scully, T
Damus, R.
Rochefellar, (Other)
Grady, R.
Hale, J.
Comments:
tony Snow
2930
118
McGroarty/Bunton
January 31, 1992
3:00 pm
[health]
PRESIDENTIAL REMARKS: GREATER CLEVELAND GROWTH ASSOCIATION
CLEVELAND, OHIO
FEBRUARY 6, 1992
XX:00 A.M.
[Introductory acknowledgements.] I'm pleased to be back in
Cleveland, capital city of the North Coast. [[opening humor...]]
People who know Northern Ohio know this region's outgrowing
the old rustbelt image. Cleveland Clinic is world-renown -- and
it is now the city's number one employer. Northern Ohio is also
welding
home to some of the most innovative approaches to health care.
The
That's why I've chosen this morning to address the health care
clivelard
crisis -- and lay out my five-point program for comprehensive
Council
health care reform. 11
smalle
Enterpris
Reform is urgent -- for more reasons than one. / The
(COSE)
crisis I mentioned isn't in quality of care. American health
[cozl
[cozy
care is first-rate, the best in the world. But the cost has
skyrocketted: from XXX in 19-- to $800 billion dollars today.
And if we keep going at the same rate, that $800 billion will
double to $1.6 trillion by the year 2000.
These numbers alone would make the case for reform. But
cold statistics don't show us the worry people feel -- the all-
too-familiar fear about what happens to their health care if they
lose their job -- or even if they leave their job for a better
one. 11 Right now, one in every seven Americans is uninsured.
And in these hard times, millions more Americans worry that if
radical Mater market based congetitive
2
they lose their job, they lose more than their paycheck -- they
lose their health insurance as well. 11
There's a better way. But the question is whether we'll sove
toward
settle on Jensible reforms -- or whether we'll force ourselves to
swallow a cure worse than the disease. Before I detail my plan,
let's take a look at some of the alternatives out there, and what
they'd do for -- or to -- America's health.
Begin with a prescription for disaster: we can nationalize
the health system. Put government in control of the system: let
government control the prices, let government ration the kind of
health care people get -- let government tell people looking for
care how much they'll get, what kind, and when.
That's the way it's done right now across Lake Erie. Yes,
Canada's system covers everyone. That's the goal we're striving
for -- but keep in mind the drawbacks that come with a
nationalized system: the waiting lists for surgery, the limits
on which doctor you see -- the shortages of the high-tech
equipment responsible for so many of the miracles of modern
medicine. 11 {Let me eite just one example: in all of Canada,
BAD
Too many
strampter
you 11 find only 12 M.R.I. machines. There are three right at
MRIS ARE
the Cleveland Clinic alone.} - - AND Acc THOSE PROBLEMS with
MUSCH HIGHER NATION TAXES.
A process
And in NEVITABLY the end, nationalizing health care/pushes costs even
would
FAR higher. Some studies of Canadian-style plans now circulating in
the Congress estimate the average American family would see its
taxes increase more than $4000 dollars a year. // You get the
- - and cost The nation move than
$250 Billian a year
3
worst of both worlds: No one has an incentive to control costs -
- and everyone pays. 11
Anyone who's spent months checking the mail for that income
tax refund -- or tried to track down a missing social security
what's
it called
check -- or whiled away a day in line at the DMV is going to
in
Ohio? ?
think long and hard before they let the government play doctor.
Nationalized health care would be a national disaster. 11
That
sould
simply
but
are
every
But there are other proposals out there equally harmful.
bit
as
One's called "Play or pay." Each employer "plays" -- provides
insurance for his employees, or they "pay" -- a payroll tax to
finance government health coverage. This scheme, says its
advocates, gives employers a choice. 11 So does the guy with
the gun in your back when he says: "Your money or your life."
Businessmen and women tell me horror stories about health
care costs spiralling out of control. Well, Play or Pay will
leave a lot of small businesses -- businesses that are on the
edge right now -- with a tough choice: They can cut workers'
wages across the board to pay for mandated health care, they can
fire some workers to cover the rest -- or raise prices, and pass
along the cost to the consumer. Some estimates put the jobs lost
under "Play or Pay" as high as half-a-million or more -- and the
cost to employers at $30 billion / and counting. 11
quaranted to be
Strip away the rhetoric, and "Play or pay" is really the
back-door route to a nationalized health scheme. It creates
incentives for employers to stop offering benefits, and dumps
millions of workers into Medicaid. And because/Play or Pay
40 losg new emp
taxes in
rest of
don 7
the plan
4
doesn't pay for itself, the American taxpayer will foot the bill.
In other words, the only sure thing about Play or Pay is pay
/ and pay / and pay. 11
Don't look for this analysis from the people pushing Play
the or
Pay. Ask them about the side-affects of their proposal, and
"malt of quarted of
&
they'll say: Take two aspirin -- and call me after the election
this
system
The fact is, we don't have to create a new government
bureacracy to give Americans access to affordable, quality health
care. We need a system that delivers -- a system that works for
America -- a system that puts quality care within reach of every
American family.
That system should be built on choice -- not central
control. It should keep costs down -- and open up access. But
above all, it should allow all Americans to rest a little easier
when it comes to health care -- to ease the worry if they change
jobs, or if they or their kids develop serious health problems.
//
sex
My comprehensive five-point plan meets every one of these
common-sense tests. Here's how:
First, we will make health insurance more affordable for
low and
lew-to-middle income families. For low-income individuals and
Contification
families, I'm proposing a health insurance credit up to $3,750
allow
those
to
poor
to
file
twees
dollars a year to/help people purchase private health insurance.
I'd create
For middle-income individuals and families, I'm urging Congress
+
to pass a health insurance tax deduction of $3,750. / Every
American family with incomes under $80,000 {-- that's wx% of all
95 million people
receive 5 new help
from
American families --} - will be eligible for either the credit or
the tax deduction. They'll find health insurance more affordable in
an impoved -- market and they'll sy stum be free to choose the plan and the doctors that
serve them best.
Second, we will make health care more efficient. Twenty
years ago, President Nixon pioneered a new idea in health care -
- the HMO. Today, I'm asking you to learn a new acronym: HIN -
- Health Insurance Networks. / Insurance costs are governed by
un
of being dick
The
Wills
the "law of large numbers:" The larger the group being insured,
the risk, is shared and the disc, administrative costs are lower - - and you ge
the lower the cost per individual. The idea beind HIN is to
provide incentives for small companies to do what Cleveland's
C.O.S.E. [COZY] group has done -- when it brought 10,000 small
businesses together to make a joint purchase of health care. By
cutting costs, we're going to make health insurance more
affordable -- and more affordable means more accessable.
Third, we will wring out waste and excess in the present
system. We've targetted malpractice for reform. You shouldn't
have to pay a lawyer when you go to the doctor. Right now,
people are doing just that: high malpractice premiums are built
into rising doctors' bills -- and passed along to the American
people. / And I am challenging the health insurance industry to
shave common forms and
cut red tape
to simplify and speed up claims processing.
[Specific challenges.]
STET
Fourth, we will get the growth in federal health programs
duly
and
under control.
Right now, {Medicare} can claim a dubious
distinction: fastest growing program in the federal budget. We
inflexible
reducing
6
won't cut benefits. We won't raise premiums. We can make real
and
control
savings simply by cutting the rate of increase. We've set a
reduce
target we can reach one that will out the rate of growth from
{10. 6& to 9.46} just reducing The nate of growth to 1090 a
year would Dave billions.
Efficiencies like this will help our reform plan pay for
itself. 11
sixth
Fifth and finally, we will get information to the people.
We will make everyone a better health care consumer. Right now,
most people pay more attention to the price of toothpaste than
the comparative costs of health care. People don't waste much
time thinking about the costs of their care -- but in the end, we
all pay the price. / We need to follow the lead of initiatives
like Cleveland Health Quality Choice -- programs that give people
"shopping" for health care a kind of "blue book" for medical
costs. Innovations like this one will help all of us keep
who want affordable quality
overall costs as low as possible.
Providing affordable care, efficient care, / wringing out
giving states flaxibility
excess and waste, controlling federal growth, and getting more
health care cost information into the hands of consumers: these
market based, competive
five points will create the kind of reform that will give
Americans the kind of health care they want and deserve -- and
put an end to the worry that keeps them awake at night.
I keep coming back to what works for this country. When we
talk about health care, we're talking about matters of the most
personal nature -- in some cases, literally, life and death
decisions. We don't need to put government between patients and
fifth - we'll give states The Heribitity
the
From The peaced jovetment to design new programs That Regram
provide quality services to all their citizens -vernalless
well produce universal acress programs for the poor That well
Amm
FACSIMILE TRANSMITTAL SHEET
NUMBER OF PAGES INCLUDING COVER 11
1
DATE
TO
2/5 Ms. AlyaGlen
92 JAN 5 P6: 37
FAX NUMBER
245-5673
COMMENTS
FROM
P.McGroads
*
DEPARTMENT OF COMMUNICATIONS
*
OFFICE NUMBER 456-2773
Pre-first draft
THE WHITE HOUSE
Office of the Press Secretary
EMBARGOED FOR RELEASE
UNTIL
:
PM (EST)
THURSDAY, FEBRUARY 6, 1992
The President's Plan
for Comprehensive Health Care Reform
The President today announced his plan for comprehensive
reform of the Nation's health care system. Following on the
outline the President offered in the State of the Union
message, the plan rejects a government takeover of the health
care system. Instead, it seeks to use market forces and
incentives to forge a more efficient health care system.
The plan responds to the three areas the President
identified when, as part of his 1990 State of the Union
message, he asked Secretary of Health and Human Services Louis
W. Sullivan to undertake a study of the cost, quality, and
accessibility of our health care system.
Reforms of the health insurance market and a new tax
credit and deduction will improve the affordability of health
care and thus increase access. Incentives to change the way
health care is delivered, reductions in the distortions created
by medical liability, support for prevention and greater
efficiency in government programs will constrain the growth in
health care costs. Support for biomedical research,
preservation of the private sector nature of the health care
system, and increased information for consumers about
providers' past performance will enhance quality.
What the Plan Accomplishes
The President's plan will:
Provide benefits to 95 million Americans through a new
health insurance tax credit and deduction;
Reduce the number of Americans without health insurance
from 34.7 million to [less than five million];
Offer help to 86 percent of all individuals who do not
already benefit from governmental medical support, with
- more -
-2-
the remaining coming from higher income individuals and
families;
Provide for a new health insurance tax credit and
deduction that will provide up to $3750 in a tax credit or
deduction, depending on family size and income. When
fully phased in, the credit and deduction will lead to a
revenue loss of $35 billion per year that will be fully
financed and thus not increase the federal budget or
deficit.
Stabilize the growth in health care costs;
Introduce insurance security for all Americans, ending the
fear that changing jobs will lead to loss of insurance
because of pre-existing health care conditions;
Reform the health insurance market to change the way
insurance is provided. Small employers would have access
to a new, more efficient way of buying health care --
Health Insurance Networks (HINs.) Small employers would
also find insurers would be required to accept all members
of employer groups and sell insurance to all;
Reduce administrative costs through streamlining the
current paperwork maze market reforms that allow small
employers to share -- and thereby substantially reduce --
administrative costs.
Expand the scope of services available in underserved
areas.
The President's plan does not:
Include price regulation or rationing of health care by
the federal government;
Burden small businesses with new mandates;
Require any tax increases;
Threaten older Americans with benefit reductions or
premium increases.
Elements of the President's Plan
The President's plan is spelled out in detail in a
page "white paper" released today; it is summarized here.
Expanding Access to Health Care
- more -
-3-
Transferable Health Insurance Tax Credits and Deductions
A transferable health insurance tax credit (certificate) and
deduction would be available to ensure access to affordable
health care coverage for moderate and low-income families.
Ninety five million Americans will benefit from these
provisions.
Both the credit and deduction would be available for costs of
health insurance of up to $1250 for individuals, [up to] $2500
for married couples and other two-person families, and [up to]
$3,750 for families of three or more. For those with employer-
provided health benefits, the maximum would be adjusted for any
employer contributions. Individuals could take either the
credit or deduction, guided by which is more financially
advantageous. The credit and deduction would benefit those
with modified adjusted gross income ranging up to:
$50,000 for single persons;
$65,000 for persons filing as heads of households,
and
$80,000 for married persons filing jointly.
[[Both the credit and the deduction would phase out in the last
$10,000 of the income range.] ]]
Transferable Health Insurance Tax Credits (Certificates)
Transferability. The credit could only be transferred to an
insurer for the purchase of health insurance; it could not be
received as cash for an individual.
Eligibility. All who do not receive other federal support
(e.g., covered by Medicare, Medicaid, and other federal health
programs) would be eligible.
Income Range. When phased in, the maximum credit would be
available to all with incomes of up to 100 percent of the tax
filing threshold -- the sum of the standard and taxpayer and
dependent exemptions, a tax code concept that approximates the
poverty threshold. Above that level, the credit would phase
down to a minimum credit at 150 percent of the tax filing
threshold. The minimum would be 10 percent of the maximum:
$125 for individuals, $250 for two person households, and $350
for households of three and larger.
- more -
-4-
Administration. Individuals who are eligible for the credit
would not need to wait until filing a tax return to obtain a
credit; a certificate could be obtained at any time during the
year by applying to a governmental office designated by state
governments. A state might select a state agency, such as the
Employment Service, or it might contract with the Social
Security Administration to certify eligibility.
Deductions
Individuals with incomes up to the top of the income range
could deduct the cost of health insurance, up to the maximum
that applies to their tax filing status (either $1250, $2500,
or $3750.) As noted above, the maximum would be adjusted for
the amount of employer contributions towards the cost of health
insurance.
Market Reform
Basic Benefits. States, working with private insurers, would
develop a basic health insurance package equal to the value of
the health insurance credit. This would enable low-income
families to purchase health care coverage.
Insurance Security. Health insurers would be required to
insure all comers. Coverage would be guaranteed and renewable.
Pre-existing conditions clauses that limit coverage during the
first months with a new employer would no longer be allowed.
Health Insurance Networks (HINs) - Pooled Purchasing Power. A
new way of purchasing insurance -- HINs -- would enable small
firms to purchase low cost, high qualify health insurance by
reducing administrative costs and by exempting insurance sold
through HINs from excessive state premium taxes. HINs would
also allow national association to sell health insurance plans
on a nationwide basis.
Mandated Benefits. Excessive mandated benefits that increase
costs and limit consumer choice over the scope of insured
benefits would not be allowed.
Insurance Affordability. In the near term, premium costs for
similar policies sold to firms in a single block of business
could vary by no more than 50 percent. A health risk
adjustment across insurers would be phased in -- removing
premium disparities and allowing for plan flexibility within a
new insurance market driven by competition on quality and
costs.
Containing Health Care Costs
- more -
-5-
Malpractice reform. Threat of malpractice litigation prompts
physicians to order tests and perform procedures simply to show
that every effort has been made to provide the best health
care. The President's plan would provide incentives to states
to: (i) eliminate joint and several liability for non-economic
damages, (ii) cap non-economic damages, (iii) eliminate rules
that permit double recovery, (iv) require structured awards,
(v) promote pretrial alternatives, and (vi) implement new
procedures to improve quality of care. Also, the implications
of standards of care, developed with the medical community,
would be considered in light of their ability to lessen
physician uncertainty over what standard of care they must
meet.
New procedural reforms would promote alternative dispute
resolution (ADR). A party that refused ADR and then lost the
suit at tiral would pay the other party its attorney fees.
Also, the potential of guidelines and standards of care to
reduce the uncertainty that leads to defensive medicine will be
explored.
Antitrust. Fear of antitrust liability has also helped produce
an often inefficient and duplicative distribution of
sophisticated services and equipment. Quality of care is
diminished by the reluctance of professional review boards and
hospitals to discipline physicians. Finally, the emergence of
managed care organizations has raised new questions about the
application of the antitrust laws to the health care system.
The President's proposal will provide enhanced [additional?]
guidance on the application of the antitrust laws in these
areas and provide a "safe harbor" for certain joint activity
relating to the sharing of equipment by providers.
Reducing administrative costs. Insurance law changes and
market reforms will end the paperwork blizzard that afflicts
all Americans with insurance -- and costs billions of dollars.
Standardized claims procedures and other reforms will reduce
administrative costs.
For small employers, administrative costs may account for as
much as 40 percent of the cost of insurance purchased, compared
to 10 percent for large employers. Marketing to and servicing
small employer policies is costly. HINs, because they bring
together many purchasers, would cut the cost of insurance
administration and therefore substantially reduce premiums.
Small businesses would benefit from these efficiencies. HINs
- more -
-6-
would follow uniform claims processing standards for additional
administrative savings.
Expanded use of coordinated care. In 1990, about 40 million
Americans were enrolled in one of a variety of coordinated care
arrangements -- up from 10 million in 1980. The President's
plan encourages broader use of coordinated care in the public
and private sectors, including preferred provider
organizations, point of service plans, case management, HMOs,
and other forms of coordinated care. New coordinated care
arrangements would be allowed in the Medicare program, states
would have incentives to use coordinated care in Medicaid
programs, and restrictions on the operation of coordinate care
in the private sector would be ended.
State mandated benefits. Excessive state mandates would not be
allowed.
Efficiencies in public programs. Health expenditures at all
levels of government account for 44 percent of national
spending on health services. Cost containment will be achieved
in these programs through greater reliance on coordinated care,
participation in the overall trend towards lower administrative
costs, recapturing some subsidies made duplicative by the new
tax credit and deduction, and aggressive action to stem program
abuses.
Increased flexibility in state programs. States would be freed
to redesign their entire health care systems. The acute care
portion of the Medicaid program, covering hospital and doctor
services, would be restructured, moving from an open ended
entitlement to a per capita payment arrangement. With this
change, current federal restrictions on the use of coordinated
care and review processes for waiver requests would be dropped.
With respect to the relationship of Medicaid to the new
transferable health insurance tax credit, states could choose
to combine current Medicaid funding with the new credit to
develop a single unified health plan for low-income persons.
Expansion of services in underserved areas. The President's FY
1993 budget expands funding for Community Health Centers,
Migrant Health Centers, and the National Health Service Corps
to expand preventive care in these areas.
Prevention. The President's budget includes $26.4 billion, a
nearly $4 billion (18 percent) increase for preventive health
activities. Prevention funding has increased over $11 billion
(74 percent) since 1989. Among other activities, the
President's FY 1993 budget proposes increases of 18 percent for
- more -
-7-
childhood immunizations and infant mortality reduction, a 27
percent increase for Head Start and Early childhood
Development, a 24 percent increase for breast and cervical
cancer mortality prevention, and a 90 percent increase for
childhood lead poisoning prevention.
Improving Consumer Information. To assist individuals and
employers shopping for insurance and health care, consumers
would have "blue books" providing comparison price and quality
data. It would cover the average cost of services and the
quality of care provided by physicians, hospitals, and clinical
laboratories.
Financing the President's Plan
The health insurance tax credit and deduction in the
President's plan will cost $35 billion per year when phased in.
Offsetting savings can be achieved through use of the measures
to contain health care costs outlined above: systems
efficiencies; reduced administrative and malpractice costs;
better behavior and the effect of preventive services to lessen
the need for health services, and greater cost-effectiveness in
publicly funded programs. No additional taxes are required or
called for.
* * *
The President's plan concludes with an analysis of the
options for health care reform that were rejected in the
President's decision making process: a national health
insurance program and a "play or pay" benefit mandate/payroll
tax. [Do we include anything about this in the fact sheet?]
WHITE HOUSE COMMCTR
TUE 04 FEB 92 18:34
PG.28
McGroarty/Bunton
February 4, 1992
11:45 am
[health]
PRESIDENTIAL REMARKS: GREATER CLEVELAND GROWTH ASSOCIATION
CLEVELAND, OHIO
FEBRUARY 6, 1992
12:00 NOON
[Introductory acknowledgements.] I'm pleased to be back in
Cleveland, capital city of the North Coast. [[opening humor...]]
People who know Northern Ohio know this region's outgrowing
the old rustbelt image. In addition to the world-renowned
Cleveland Clinic -- now the city's number one employer --
Northern Ohio is also home to some of the most innovative
approaches to health care. COSE [COZY] and Cleveland Health
Quality Choice are pioneers: communities across the country can
follow your lead to create Workable solutions to health care
challenges. / That's why I've chosen to come to Cleveland this
morning to address the health care crisis -- and lay out my four-
point program for comprehensive health care reform. 11
Reform is urgent -- for more reasons than one. / Right
now, far too many Americans are uninsured -- and those who are
insured pay too much for health care. And we're going to do somethi
about that.
The one thing this crisis isn't about is quality of care.
American health care is first-rate, the best in the world. And
right now, the vast majority of Americans have access to that
health care system. But the cost has skyrocketed: from XXX in
19-- to $800 billion dollars today. And if we keep going at the
same rate, that $800 billion will double to $1.6 trillion by the
year 2000.
Photocopy-Preservation
WHITE HOUSE COMMCTR
TUE 04 FEB 92 18:35
PG.29
2
These numbers alone would make the case for reform. But
cold statistics don't show us the worry people feel -- the all-
too-familiar fear about what happens to their health care if they
change jobs -- or worse still, if they lose their jobs. 11 And
in these hard times, we simply cannot accept the fact that one in
every seven Americans is uninsured. 11
There's a better way. / My plan puts the emphasis on
expanding access - while preserving the choice people now have
over the type of health coverage and health care they receive.
eye
My plan will give Americans a greater sense of security -- help
ease the fears so many Americans have that changing jobs will
Charging the system to ensure
cost them their health coverage: by encouraging coverage that is
people that they always have access to health insurance no matter where
portable coverage that employees can carry with them.
they 80-
Finally my plan will cut costs. It helps us make health
no matter
what.
insurance more affordable -- and more affordable means more
accessible.
My plan will preserve what works -- and reform what doesn't.
And above all, it will ensure every American universal access to
basic health care. 11
we stand at a crossroads. We can settle on sensible reforms
--- or we can force ourselves to swallow a cure worse than the
disease.
Some people have scribbled out a prescription for disaster:
they want to nationalize the health system. Put government in
control of the system: let government control the prices, let
government ration the kind of health care people get -- let
WHITE HOUSE COMMCTR
TUE 04 FEB 92 18:35
PG.30
3
government tell people looking for care how much they'l get,
what kind, and when.
Right now, across Lake Erie, Canada's system covers
everyone. But keep in mind the drawbacks that come with a
nationalized system: long waiting lists for surgery -- shortages
of the high-tech equipment responsible for so many of the
miracles of modern medicine. 11 {Let me cite just one example:
the Magnetic Resonance Imaging technology the M.R.I
used
new
to diagnose everything from tumors to torn cartilage. In all of
Canada, you'll find only 12 M.R.I. machines. There are 15 right
here in Greater Cleveland alone.}
When you nationalize health care, you push costs higher
I
far higher. Some studies estimate that a Canadian-style plan
huge new trx bruden
would cost the average American family more than $4000 dollars a
to 500
year And, -- for the nation, a staggering $250 billion dollars a year new
tones
11 For that price, you get the worst of both worlds: No one has
Such a
an incentive to control costs -- and everyone pays.
that sound single unt are every
But there are other proposals out there equally harmful. as
tax increase
massive and
One's called "Play or pay." Each employer must "play" --
is burously cegardic
meaning: provide insurance for employees, or "pay" -- a payroll
tax to finance government health coverage.
Businessmen and women tell me horror stories about health
care costs spiralling out of control. Well, Play or Pay will
leave a lot of small businesses -- businesses struggling on the
edge of survival right now -- with a tough choice: They can cut
workers' wages to pay for mandated health care, they can fire
WHITE HOUSE COMMCTR
TUE 04 FEB 92 18:36
PG.31
4
some workers to cover the rest -- or they can raise prices, and
pass along the cost to the consumer. Some studies put the cost
in jobs lost under "Play or Pay" as high as half-a-million or
more.
strip away the rhetoric, and "Play or pay" just creates a
back-door route to a nationalized health care. It encourages
employers to stop offering benefits, throw the problem in the
government's lap, and dump millions of fully-insured workers into apublic
thenew employer taxesin
the program
plan
Medicaid. And because Play or Pay doesn't pay for itself, the
like
medicaid
American taxpayer will foot the bill.
You won't hear this from the people pushing Play or Pay.
Ask them about the side-affects of their proposal, and they'll
say: Take two aspirin -- and call me after the election. like
We can't keep ignoring problems people care about and I
won't. People don't want to be shoveled into some new health
care bureaucracy. They want good health. 11 A large part of
the answer is prevention: the changes each one of us can make to
avoid behavior that raises risk of disease and illness.
Tomorrow, in San Diego, I'll focus in more detail on the ways
prevention can help people live healthier lives -- and help keep
our economy healthy, too.
But today, I want to focus on the health care system -- on
my comprehensive, market-based reform plan. / The fact is, we
don't have to create a new government bureaucracy to give
Americans access to affordable, quality health care. We need a
system that delivers -- a system that works for America -- a
WHITE HOUSE COMMCTR
TUE 04 FEB 92 18:36
PG.32
5
system that puts quality care within reach of every American
family.
our system should be built on choice -- not central control.
It should keep costs down -- and open up access. But above all,
it should allow all Americans to rest secure when it comes to
health care -- to ease their worry that if they change jobs, if
they or their kids develop serious health problems, they'll still
be able to count on the coverage they need. 11
My comprehensive four-point plan meets every one of these
common-sense tests. Here's how:
Point one: we will make health care more accessible by
making health insurance more affordable. For low-income
individuals and families, I propose a health insurance credit --
quarantee
up to $3,750 dollars a year to help people, even people too poor
to file taxes, purchase private health insurance. Each will
have
receive a certificate or voucher for more than $300 dollars a
month. They can use it to buy into the plan their employers
offer but they could never afford -- or they can shop for
whatever private plan suits them best.
For middle-income individuals and families, I propose a
health insurance tax deduction of $3,750.
/
Every American.
of upto
that's a lot of American families
familigswith incomes under $80,000 -- that 95 million Americans
-- will receive new help from either the credit or the tax
deduction. 95 million Anericans would get new help to purchase
health insure
insurance
Once again, this coverage will be portable: people who
would have mousuand regardlessofibeinhealth - andthis 4 inportant-
change jobs ^ can take their coverage with them.
or their family's
health
WHITE HOUSE COMMCTR
TUE 04 FEB 92 18:37
PG.33
But best of all, will bring security to 30 million uninsured
Americans -- people who will at long last receive health care
coverage they'd had to do without. 11
That's the first point in my four-point plan: access.
Point two; we will cut the runaway costs of health care by
making the system more efficient. Today, I'm asking you to learn
a new acronym: HIN -- Health Insurance Networks. / Insurance
costs obey the "law of large numbers:" The larger the group
being insured, the lower the cost per individual. HIN's provide
incentives for small companies to do what Cleveland's C.O.S.E.
[COZY] group has done -- when it brought 11,000 small businesses
together to make a joint purchase of health care.
Another way to drive costs down: make everyone a better
health care consumer. Right now, most people pay more attention
to the price of toothpaste than the comparative costs of health
care. People don't waste much time thinking about the costs of
their care -- but in the end, we all pay the price. We need to
follow the lead of initiatives like Cleveland Health Quality
Choice -- programs that give people "shopping" for health care a
kind of "blue book" for medical costs. 11 Innovations like
these will help all of us keep the costs of quality health care
as low as possible.
Point Three: we will wring out waste and excess in the
present system. We've targeted medical malpractice for reform.
You shouldn't have to pay a lawyer when you go to the doctor.
Right now, people do just that: high malpractice premiums mean
WHITE HOUSE COMMCTR
TUE 04 FEB 92 18:37
PG.34
7
higher doctors' bills -- as they pass their legal bills along to
you. / I have challenged the health insurance industry to cut
red tape -- to share common forms, and to simplify and speed up
that almost
claims processing. There is no reason half of all health
insurance claims can't be processed electronically within the
next four years. That single step would eliminate a mountain
health care paperwork and pare back costs.
Fourth and finally, we will get the growth in federal health
programs under control. Right now, government health care
programs can claim a dubious distinction: they are the fastest
growing parts in the federal budget. / We must bring runaway
costs under control. We won't 'cut benefits. We won't raise
premiums. we can make real savings simply by reducing the rate
of increase.
Efficiencies like this will help our reform plan pay for
itself. 11
The federal government should also give states the
flexibility to design new universal access programs for the poor
-- programs that will provide quality services to all their
citizens. States will be able to use new federal resources to
design programs that work -- not one-size-fits-all solutions
imposed by Washington.
Providing affordable care, efficient care, / wringing out
excess and waste and controlling federal growth: these four
points will create the kind of market-based reform plan that will
WHITE HOUSE COMMCTR
TUE 04 FEB 92 18:37
PG.35
8
give Americans the kind of health care they want and deserve --
and put an end to the worry that keeps them awake at night.
Remember what people want. People want care they can afford
/ care they can carry with them / and care they can count on.
I keep coming back to what works for this country. When we
talk about health care, we're talking about matters of the most
personal nature -- in some cases, literally, life and death
decisions. We don't need to put government between patients and
their doctors. We don't need to create another wasteful federal
bureaucracy We need common sense, comprehensive health care
reform -- and we need it now. My four point plan is the right
plan -- a plan that meets our obligation to all Americans by
putting hope and health within their reach. 11
once again, my thanks for this warm Cleveland welcome. May
God bless the United States of America.
# # #
DD- F41- Revised. DMcG
McGroarty/Bunton
February 3, 1992
7:30 pm
[health]
PRESIDENTIAL REMARKS: GREATER CLEVELAND GROWTH ASSOCIATION
CLEVELAND, OHIO
FEBRUARY 6, 1992
12:00 NOON
[Introductory acknowledgements.] I'm pleased to be back in
Cleveland, capital city of the North Coast. [[opening humor ]]
People who know Northern Ohio know this region's outgrowing
the old rustbelt image. Cleveland Clinic is world-renowned --
including
and it is now the city's number one employer -- and Northern Ohio
Casceland
is also home to some of the most innovative approaches to health
cannot
care / That's why I've chosen this morning to address the
small of
five
health care crisis -- and lay out my four-point program for
interprises (cozy")
?
7
comprehensive health care reform. //
Reform is urgent --- for more reasons than one. / The
crisis I mentioned isn't in quality of care. American health
care is first-rate, the best in the world. And right now, the
vast majority of Americans have access to that health care
system. But the cost has skyrocketted: from XXX in 19-- to $800
billion dollars today. And if we keep going at the same rate,
that $800 billion will double to $1.6 trillion by the year 2000.
These numbers alone would make the case for reform. But
cold statistics don't show us the worry people feel -- the all-
too-familiar fear about what happens to their health care if they
change their job -- or worse still, if they lose their job. //
And in these hard times, it is simply unacceptable that one in
every seven Americans is uninsured. //
2
There's a better way. / My plan puts the emphasis on
expanding access -- while preserving the choice people now have
over the type of health coverage and health care they receive.
My plan will give Americans a greater sense of security -- help
ease the fears so many Americans have that changing jobs will
cost them their health coverage: by encouraging coverage that is
changing the System X ensure
added
That they'll always have access to in surance.
portable coverage that an employee can carry with them.
No
Finally by cutting costs, we're going to make health insurance
more affordable -- and more affordable means more accessable.
My plan will preserve what works -- and reform what doesn't.
And above all, it will ensure every American universal access to
affor lable
basic health care
coverage
We're at a crossroads. The question now is whether we'll Move toward
dramatic market based competitive
settle on sensible reforms -- or whether we'll force ourselves to
swallow a cure worse than the disease.
Some people are pushing a prescription for disaster: we can
nationalize the health system. Put government in control of the
system: let government control the prices, let government ration
the kind of health care people get -- let government tell people
looking for care how much they'll get, what kind, and when.
Right now, across Lake Erie, Canada's system covers
everyone. That's the goal we're striving for -- but keep in mind
the drawbacks that come with a nationalized system: the long
waiting lists for surgery -- the shortages of the high-tech
equipment responsible for so many of the miracles of modern
medicine. // Let me cite just one example: the Magnetic
Optin lat ve Date just are example. The clavelure Clainic does
Claveland Chinic Bipoos Surgery.
Coronary bypass
The
surgeries a day;
Mt. Sinai Hospital. which I just visited does - a day. Hightech, high
quality surgery without any wait. But it you were
in British Columbia you have to wait 6 months for erronary
bypass surgery- It's no wonder Scatte's hospitals see lots
of Candians
3
Resonance Imaging techology -- the M.R.I. -- used to diagnose
everything from tumors to torn cartilage. In all of Canada,
you'll find only 12 M.R.I. machines. There are 15 right here in
Greater Cleveland alone.
In the end, nationalizing health care pushes costs even
higher. Some studies of Canadian-style plans now circulating in
from
or
the Congress estimate the costs of that plan for the average
This
requiring
#250 10500 Billion
American family at more than $4000 dollars a year. 5 // You get
massive
a you
the worst of both worlds: No one has an incentive to control
in
new taxes.
costs -- and everyone pays. //
visacceptable
is
that seem sumple but are every stas
But there are other proposals out there, equally harmful.
One's called "Play or pay." Each employer must "play" --
meaining: provide insurance for his employees, or they "pay" --
a payroll tax to finance government health coverage.
Businessmen and women tell me horror stories about health
care costs spiralling out of control. Well, Play or Pay will
leave a lot of small businesses -- businesses that are on the
edge right now -- with a tough choice: They can cut workers'
wages across the board to pay for mandated health care, they can
fire some workers to cover the rest -- or they can raise prices,
and pass along the cost to the consumer. Some estimates put the
jobs lost under "Play or Pay" as high as half-a-million or more.
Strip away the rhetoric, and "Play or pay" is really the
back-door route to a nationalized health scheme. It creates
incentives for employers to stop offering benefits, and dumps
o public program like
millions of workers into Medicaid. And because Play or Pay
The new eng loyer
fully
?
taxes in
isursed
K
4
don't
the program
doesn' pay for itself, the American taxpayer will foot the bill.
You won't hear this from the people pushing Play or Pay.
Ask them about the side-affects of their proposal, and they'll
say: Take two aspirin -- and call me after the election. //
The fact is, we don't have to create a new government
bureacracy to give Americans access to affordable, quality health
care. We need a system that delivers -- a system that works for
America -- a system that puts quality care within reach of every
American family.
Our system should be built on choice -- not central control.
It should keep costs down -- and open up access. But above all,
it should allow all Americans to rest secure when it comes to
health care -- to ease their worry that if they change jobs, or
if they or their kids develop serious health problems, they won't
be able to count on the coverage they need. //
My comprehensive four-point plan meets every one of these
common-sense tests. Here's how:
Point one: we will make health care more accessable by
making health insurance more affordable. For low-income
individuals and families I'm proposing a health insurance credit
even These too poor to file taxes-A
-- up to $3,750 dollars a year to help people purchase private
have
them
health insurance. Each will receive a certificate or voucher for
raneth care
more than $300 dollars a month. They can use it to buy into the
plan their employers offer but they could never afford -- or they
can shop for whatever private plan suits them best.
5
For middle-income individuals and families, I'm urging
STAT
Congress to pass a health insurance tax deduction of $3,750. /
ics
Every American family with incomes under $80,000 -- that is S 95°
of up to
well
million Americans
will be eligible for either the credit or
the
tax deduction. 95 willin Americans would get new help to purchase
health insurance
Once again, this insurance coverage will be portable: people who the status
would have insurance regardless of their health or
change jobs can take their coverage with them.
Their formly's health.
and this
But best of all, will bring security to 30 million uninsured
Americans -- people who will at long last receive health care
coverage they'd had to do without. //
Goverage and
That's the first point in my four-point plan: access.
Point two: we will cut the runaway costs of health care by
making the system more efficient. Today, I'm asking you to learn
a new acronym: HIN -- Health Insurance Networks. / Insurance
costs are governed by the "law of large numbers:" The larger the
Effective
group being insured, the lower the cost per individual. The idea
"pooling"
beind HIN is to provide incentives for small companies to do what
lowers
insurance
Cleveland's C.O.S.E. [COZY] group has done -- when it brought
costs and
significanth
11,000 small businesses together to make a joint purchase of
lowers administration
health care.
advinistrative costs
Another way to drive costs down is to make everyone a better
spriod
health care consumer. Right now, most people pay more attention
to the price of toothpaste than the comparative costs of health
care. People don't waste much time thinking about the costs of
their care -- but in the end, we all pay the price. We need to
follow the lead of initiatives like Cleveland Health Quality
without the inflexible mandates of pregrams designed
These programs will be designed at the state level -
by & in washington,
and Generatic
6
Choice -- programs that give people "shopping" for health care a
kind of "blue book" for medical costs.
Point Three: we will wring out waste and excess in the
present system. We've targeted medical malpractice for reform.
lawsist
awards
You shouldn't have to pay a lawyer when you go to the doctor.
are
Right now, people are doing just that: high malpractice premiums
are built into rising doctors' bills -- and passed along to the
American people. / And I am challenging the health insurance
industry to cut red tape -- to simplify and speed up claims
That virtually
processing. There is no reason half of all health insurance
through standard common Forms
claims can't be precessed electronically/within the next four
years. That single step would eliminate a mountain health care
paperwork and pare back costs.
fifth
Fourth and finally, we will get the growth in federal health
programs under control. Right now, government care programs can
claim a dubious distinction: they are the fastest growing parts
in the federal budget. We won't cut benefits. We won't raise
premiums. We can make real savings simply by cutting the rate of
increase.
Efficiencies like this will help our reform plan pay for
itself. //
Providing affordable care, efficient care, / wringing out
excess and waste and controlling federal growth: these four
points will create the kind of reform that will give Americans
the kind of health care they want and deserve -- and put an end
to the worry that keeps them awake at night.
fourth, within The reformed system, we'll give States the flexibility
to design universal access programs for the poor that meet there will
individual wells of Their states with new federal help, citizens, 3 the
provide quality care to ace Their atizens. Programs to meet the
new federal help to reduce The state's broom.
7
I keep coming back to what works for this country. When we
talk about health care, we're talking about matters of the most
personal nature -- in some cases, literally, life and death
decisions. We don't need to put government between patients and
their doctors. We don't need to create another wasteful federal
bureaucracy. We need common sense, comprehensive health care
reform -- and we need it now. My four-point plan is the right
plan -- a plan that meets our obligation to all Americans by
putting hope and health within their reach. //
Once again, my thanks for this warm Cleveland welcome. May
God bless the United States of America.
# # #
Has Kuttnr
February 3, 1992
Dear Dick:
While I don't agree with it, I understand the decision to
have the president articulate a plan on Thursday. What he does
with the other twelve minutes of his speech is essential, because
he will never have a better opportunity to define this issue as
it needs to be defined. This chance won't come again.
My argument is that on Thursday the President must define
the health problem broadly, in order to advance three key
strategic needs:
like life initating ant:
1. The democrats have already defined our health crisis as letters
reported and talked about. We cannot win on the field the
a problem of access. We can't let that stand. That's how it is imitating
democrats have chosen to play on. They will one-up us every time speechs
and our plans will look anemic by comparison.
And as long as "financing access" is the scope of the issue,
the pressure will be on the President to find resources to pay
for it: from Medicare, means testing or a tax cap, which makes us
look draconian.
2. The policy reality is that our problem is much broader
than access. Access is just one of three major problems we
face, the other two being the wasteful way we practice and pay
for medicine and the increasingly poor health habits of the
American people. Solving the health crisis absolutely requires
progress on all three.
The heavy lifting ahead is not just for government to do.
The challenge must be issued to the medical community and the
insurance companies to change how we practice and pay for
medicine, so we get more and better care for the same dollars.
The challenge must also be to the American people, that they must
take more responsibility for their own health, by living
lifestyles that keep them well.
3. By talking about re-inventing medical practice
(rewarding efficient providers, liability reform), personal
health responsibility (on which he is an excellent spokesman,
consumer information) as well as financing access (tax credits +
insurance reform + medicaid changes), the President can be the
first person to tackle the whole problem.
It's a war on three fronts. We can't afford to ignore any
of them. We need to put the right assets against each
challenges. The democrats have only one weapon: more government.
It won't work. Instead, we need to marshall the inventiveness of
the American people, the character of the American people and yes
the regulatory and financial resources of government ap-all
levels. Together we can win this war
Document No. 304159
WHITE HOUSE STAFFING MEMORANDUM
92 JAN 4 P4: 32
DATE: 2/1/92
ACTION/CONCURRENCE/COMMENT DUE BY: MONDAY, 4:00 PM, 2/3/92
PRESIDENTIAL REMARKS: GREATER CLEVELAND GROWTH ASSOCIATION
CLEVELAND, OHIO
SUBJECT:
FEBRUARY 6, 1992
ACTION FYI
ACTION FYI
VICE PRESIDENT
HORNER
SKINNER
MCCLURE
SCOWCROFT
PETERSMEYER
DARMAN
PORTER
BRADY
ROGICH or
BROMLEY
SMITH
FINDLAY
CARD
DEMAREST
SNOW
FITZWATER
KAUFMAN
GRAY
BOSKIN
HOLIDAY
REMARKS:
Please forward your comments directly to Tony Snow, Rm. 122, x2930,
with a copy to this office NO LATER THAN 4:00 PM, MONDAY, FEBRUARY 3.
Thank you.
RESPONSE:
See page Smithur Sorry for but 4 Pet the this am, Assistant PHILLIP and Staff Ext. to D.
114A BRADY
the President
Secretary
2702
McGroarty/Bunton
January 31, 1992
3:00 pm
32 JAN31 P4: 29
[health]
PRESIDENTIAL REMARKS:
GREATER CLEVELAND GROWTH ASSOCIATION
CLEVELAND, OHIO
FEBRUARY 6, 1992
XX:00 A.M.
[Introductory acknowledgements.] I'm pleased to be back in
Cleveland, capital city of the North Coast. [[opening humor...]]
People who know Northern Ohio know this region's outgrowing
the old rustbelt image. Cleveland Clinic is world-renown -- and
it is now the city's number one employer. Northern Ohio is also
home to some of the most innovative approaches to health care. /
That's why I've chosen this morning to address the health care
crisis -- and lay out my five-point program for comprehensive
health care reform. //
Reform is urgent -- for more reasons than one. / The
crisis I mentioned isn't in quality of care. American health
The crisis is in health care cost whath
care is first-rate, the best in the world. A But the cost has
skyrocketted: from XXX in 19-- to $800 billion dollars today.
And if we keep going at the same rate, that $800 billion will
double to $1.6 trillion by the year 2000.
These numbers alone would make the case for reform. But
cold statistics don't show us the worry people feel -- the all-
too-familiar fear about what happens to their health care if they
lose their job -- or even if they leave their job for a better
one. // Right now, one in every seven Americans is uninsured.
And in these hard times, millions more Americans worry that if
2
they lose their job, they lose more than their paycheck -- they
lose their health insurance as well. //
There's a better way. But the question is whether we'll
settle on sensible reforms -- or whether we'll force ourselves to
swallow a cure worse than the disease. Before I detail my plan,
let's take a look at some of the alternatives out there, and what
they'd do for -- or to -- America's health.
Begin with a prescription for disaster: we can nationalize
the health system. Put government in control of the system: let
government control the prices, let government ration the kind of
health care people get -- let government tell people looking for
care how much they'll get, what kind, and when.
That's the way it's done right now across Lake Erie. Yes,
Canada's system covers everyone. That's the goal we're striving
for -- but keep in mind the drawbacks that come with a
nationalized system: the waiting lists for surgery, the limits
on which doctor you see -- the shortages of the high-tech
equipment responsible for so many of the miracles of modern
medicine. // {Let me cite just one example: in all of Canada,
you'll find only 12 M.R.I. machines. There are three right at
the Cleveland Clinic alone.}
And in the end, nationalizing health care pushes costs even
higher. Some studies of Canadian-style plans now circulating in
the Congress estimate the average American family would see its
taxes increase more than $4000 dollars a year. // You get the
3
worst of both worlds: No one has an incentive to control costs -
- and everyone pays. //
Anyone who's spent months checking the mail for that income
tax refund -- or tried to track down a missing social security
check -- or whiled away a day in line at the DMV is going to
think long and hard before they let the government play doctor.
Nationalized health care would be a national disaster. //
But there are other proposals out there, equally harmful.
One's called "Play or pay. Each employer "plays" -- provides
insurance for his employees, or they "pay" -- a payroll tax to
finance government health coverage. This scheme, says its
advocates, gives employers a choice. // So does the guy with
the gun in your back when he says: "Your money or your life. "
Businessmen and women tell me horror stories about health
care costs spiralling out of control. Well, Play or Pay will
leave a lot of small businesses -- businesses that are on the
edge right now -- with a tough choice: They can cut workers'
wages across the board to pay for mandated health care, they can
fire some workers to cover the rest -- or raise prices, and pass
along the cost to the consumer. Some estimates put the jobs lost
under "Play or Pay" as high as half-a-million or more -- and the
cost to employers at $30 billion / and counting. //
Strip away the rhetoric, and "Play or pay" is really the
back-door route to a nationalized health scheme. It creates
incentives for employers to stop offering benefits, and dumps
millions of workers into Medicaid. And because Play or Pay
4
doesn't pay for itself, the American taxpayer will foot the bill.
In other words, the only sure thing about Play or Pay is pay
/ and pay / and pay. //
Don't look for this analysis from the people pushing Play or
Pay. Ask them about the side-affects of their proposal, and
they'll say: Take two aspirin -- and call me after the election.
The fact is, we don't have to create a new government
bureacracy to give Americans access to affordable, quality health
care. We need a system that delivers -- a system that works for
America -- a system that puts quality care within reach of every
American family.
That system should be built on choice -- not central
control. It should keep costs down -- and open up access. But
above all, it should allow all Americans to rest a little easier
when it comes to health care -- to ease the worry if they change
jobs, or if they or their kids develop serious health problems.
//
My comprehensive five-point plan meets every one of these
common-sense tests. Here's how:
First, we will make health insurance more affordable for
low-to-middle income families. For low-income individuals and
families, I'm proposing a health insurance credit -- up to $3,750
dollars a year to help people purchase private health insurance.
For middle-income individuals and families, I'm urging Congress
to pass a health insurance tax deduction of $3,750. / Every
American family with incomes under $80,000 {-- that's xx% of all
5
American families --} will be eligible for either the credit or
the tax deduction. They'll find health insurance more affordable
-- and they'll be free to choose the plan and the doctors that
serve them best.
financing
Second, we will make health care more efficient. Twenty
years ago, President Nixon pioneered a new idea in health care
- the A acronym: HIN
HMO. I Today, want to I'm proneer asking a you new to idea learn in a health new care financing: -
- Health Insurance Networks. / Insurance costs are governed by
the "law of large numbers:" The larger the group being insured,
the lower the cost per individual. The idea beind HIN'Jis to. will
provide incentives for small companies to do what Cleveland's
C.O.S.E. [COZY] group has done -- when it brought 10,000 small
businesses together to make a joint purchase of health care. By
cutting costs, we're going to make health insurance more
affordable -- and more affordable means more accessable.
remove the
Third, we will wring out waste and excess in the present
system. We've targetted malpractice for reform. You shouldn't
have to pay a lawyer when you go to the doctor. Right now,
people are doing just that: high malpractice premiums are built
into rising doctors' bills -- and passed along to the American
people.
Inaddition
/
/
And I am challenging the health insurance industry to
cut red tape -- to simplify and speed up claims processing.
[Specific challenges.]
control
Fourth, we will get the growth in federal health programs.
under control Right now, {Medicare} can claim a dubious
distinction: fastest growing program in the federal budget. We
6
won't cut benefits. We won't raise premiums. We can make real
savings simply by cutting the rate of increase. We've set a
target we can reach -- one that will cut the rate of growth from
{10.6% to 9.4%}.
Efficiencies like this will help our reform plan pay for
itself. //
consumer
Fifth and finally, we will get information to the people.
We will make everyone a better health care consumer. Right now,
most people pay more attention to the price of toothpaste than
the comparative costs of health care. People don't waste much
time thinking about the costs of their care -- but in the end, we
all pay the price. / We need to follow the lead of initiatives
like Cleveland Health Quality Choice -- programs that give people
"shopping" for health care a kind of "blue book" for medical
costs. Innovations like this one will help all of us keep
overall costs as low as possible.
Providing affordable care, efficient care, / removing wringing out
excess and waste, controlling federal growth, and getting more
health care cost information into the hands of consumers: these
five points will create the kind of reform that will give
Americans the kind of health care they want and deserve -- and
put an end to the worry that keeps them awake at night.
Insert A next
I keep coming back to what works for this country.
When we
page
talk about health care, we're talking about matters of the most
personal nature -- in some cases, literally, life and death
decisions. We don't need to put government between patients and
4
and health care providers.
their doctors We don't need to create another wasteful federal
bureaucracy. We need common sense comprehensive)health care
reform -- and we need it now. My five-point plan is the right
plan -- a plan that meets our obligation to all Americans by
the hope of quality health care
putting ^ hope and health within their reach. //
Once again, my thanks for this warm Cleveland welcome. May
God bless the United States of America.
# # #
These strengths include
The freedom of individuals to choose physicians, hospitals and
health plans; diversity and flexibility in the financing,
organization and delivery of care; physicians and health
professionals who are the best educated and most skilled in the
A
world; millions of volunteers who assist in providing quality
health care; world leadership in biomedical research; dramatic
technological innovation and leadership in new methods of
assuring quality care.
HITS ifional
comments
McGrearty Bunton
February 4, 1992
1145 pm
[health]
PRESIDENTIAL REMARKS: GREATER CLEVELAND GROWTH ASSOCIATION
CLEVELAND, OHIO
FEBRUARY 6, 1992
12:00 NOON
[Introductory acknowledgements.] I'm pleased to be back in
Cleveland, capital city of the North Coast. [[opening humor...]]
People who know Northern Ohio know this region's outgrowing
the old rustbelt image. In addition to the world-renowned
Cleveland Clinic -- now the city's number one employer --
Northern Ohio 1s also home to some of the most innovative
approaches to health care. COSE [COZY] and Cleveland Health
Quality Choice are pioneers: communities across the country can
follow your lead to create workable solutions to health care
challenges. / That's why I've chosen to come to Cleveland this
morning to address the health care crisis -- and lay out my four-
point program for comprehensive health care reform. 11
Reform is urgent -- for more reasons than one. / Right
now, far too many Americans are uninsured -- and those who are
insured pay too much for health care.
The one thing this crisis isn't about is quality of care.
American health care is first-rate, the best in the world. And
right now, the vast majority of Americans have access to that
health care system. But the cost has skyrocketed: from XXX in
19-- to $800 billion dollars today, And if we keep going at the
same rate, that $800 billion will double to $1.6 trillion by the
year 2000.
41 out of every#7 dollars we spend
2
These numbers alone would make the case for reform. But
cold statistics don't show us the worry people feel -- the all-
too-familiar fear about what happens to their health care if they
change jobs -- or worse still, if they loss their jobs. 11 And
in these hard times, we simply cannot accept the fact that one in
every seven Americans is uninsured. 11
There's a better way. / My plan puts the emphasis on
expanding access -- while preserving the choice people now have
over the type of health coverage and health care they receive.
My plan will give Americans a greater sense of security -- help
sase the fears so many Americans have that changing jobs will
cost them their health coverage: (by by encouraging coverage that is
portable -- coverage that employees can carry with them. )
delete
Add
Finally, my plan will out costs. It helps us make health By Allowing
workers to change
insurance more affordable -- and more affordable means more jobs without
fear of losing
accessible.
coverage
My plan will preserve what works - and reform what doesn't.
And affordable above all, it will ensure every American universal access to
insurance
basic health mare.
very important or delete paragraph
We stand at a crossroads. We can settle on sensible reforms
-- or we can force ourselves to swallow a cure worse than the
disease.
Some people have scribbled out a prescription for disaster:
they want to nationalize the health eystem. Put government in
control of the system: let government control the prices, let
government ration the kind of health care people get -- let
3
government tell people looking for care how much they'll get,
what kind, and when.
Right now, across Lake Erie, Canada's system covers
everyone. But keep in mind the drawbacks that come with a
nationalized system: long waiting lists for surgery -- shortages
of the high-tech equipment responsible for so many of the
miracles of modern medicine. / (Let me cite just one example:
the Magnetic Resonance Imaging technology - the M.R.T. -- used
to diagnose everything from tumors to torn cartilage. In all of
Canada, you'll find only 12 M.R.I. machines. There are 15 right
Delete or Add something to suggest
here in Greater Cleveland alone.)
that we have toomany or Canda few too
When you nationalize health care, you push sosts higher --
taxes
far higher. Some studies estimate that a Canadian-style plan
in
taxes
would cost the average American family more than $4000 dollars
year -- for the nation, a staggering $250 billion dollars a year.
11 For that price, you get the worst of both worlds: No one has
an incentive to control costs -- and averyone Days. 11
But there are other proposals out there, equally harmful.
one's called "Play or pay." Each employer must "play" --
meaning: provide insurance for employees, or "pay" -- a payroll
tax to finance government health coverage.
Businessmen and women tell me horror stories about health
care costs spiralling out of control. Well, Play or Pay will
leave a lot of small businesses -- businesses struggling on the
edge of survival right now -- with a tough choice: They can cut
workers' wages to pay for mandated health care, they can fire
P05
4
some workers to cover the rest -- or they can raise prices, and
pass along the cost to the consumer. some studies put the cost
in tobs lost under "Play or Pay" as high as half-a-million or
more.
strip away the rhetoric, and "Play or pay" just creates a
back-door route to a nationalized health care. It encourages
employers to stop offering benefits, throw the problem in the
government's lap, and dump millions of fully-insured workers into
Medicaid. And because Play or Pay doesn't pay for itself, the
American taxpayer will foot the bill.
You won't hear this from the people pushing Play or Pay.
Ask them about the side-affects of their proposal, and they'll
say: Take two aspirin -- and call me after the election. 11
We can't keep ignoring problems people care about -- and I
won't. People don't want to be shoveled into some new health
care bureaucracy. They want good health. 11 A large part of
the answer is prevention: the changes each one of us can make to
avoid behavior that raises risk of disease and illness.
Tomorrow, in San Diago, I'll focus in more detail on the ways
prevention can help people live healthier lives -- and help keep
our economy healthy, too.
But today, I want to focus on the health care system -- on
my comprehensive, market-based reform plan. / The fact is, we
don't have to create a new government bureaucracy to give
Americans access to affordable, quality health care. We need a
system that delivers -- a system that works for America -- a
5
system that puts quality care within reach of every American
family.
our system should be built on choice -- not central control.
It should keep costs down -- and open UD access. But above all,
it should allow all Americans to rest seoure when it comes to
health care -- to case their worry that if they change jobs, if
they or their kids develop serious health problems, they'll still
be able to count on the coverage they need. 11
My comprehensive four-point plan meets every one of these
common-sense tests. Here's how:
Point one: we will make health care more accessible by
making health insurance more affordable. For low-income
individuals and families, I propose a health insurance credit --
up to $3,750 dollars a year to help people, even people too poor
to file taxes, purchase private health insurance. Each will
receive a certificate or voucher for more than $300 dollars a
month. They can use it to buy into the plan their employers
offer but they could never afford -- or they can shop for
whatever private plan suits them best.
tax deduction
For middle-income individuals and families, I propose a
plases out
health insurance tax deduction of $3,750.
/
Every American
after 80,00
70,000
90
70,000 70,
family with incomes under $80,000 -- that's 25. million Americans
might bx
-- will receive new help from either the credit or the tax
a better be number
deduction.
Once again, this coverage will be portable: people who
delete
change jobs can take their coverage with them.
6
But best of all, will bring security to 30 million uninsured
Americans -- people who will at long last receive health care
coverage they'd had to to kithopt. 11
have available affordable
That's the first point in my four-point plan: access. health
insurance
Point two: we will out the runaway costs of health care by
making the system more efficient. Today, I'm asking you to learn
a new acronym: HIN -- Health Insurance Networks. / Insurance
costs obey the "law of large numbers:" The larger the group will
being insured, the lower the cost per individual. HIN's provide
incentives for small companies to do what Cleveland's C.O.S.E.
[COZY] group has done -- when it brought 11,000 small businesses
together to make a joint purchase of health care.
Another way to drive costs down: make everyone a better
health care consumer. Right now, most people pay more attention
to the price of toothpaste than the comparative costs of health
care. People don't waste much time thinking about the costs of
their care -- but in the end, we all pay the price. We need to
follow the lead of initiatives like Cleveland Health Quality
Choice -- programs that give people "shopping" for health care a
kind of "blue book" for medical costs. 11 Innovations like
these will help all of us keep the costs of quality health care
as low as possible.
point Three: we will wring out waste and excess in the
present system. We've targeted medical malpractice for reform.
You shouldn't have to pay a lawver when you go to the doctor.
Right now, people do just that: high malpractice premiums mean
7
higher doctors' bills -- as they pass their legal bills along to
you. / I have challenged the health insurance industry to out
red tape -- to share common forms, and to simplify and spead up
claims processing. {There is no reason half of all health
insurance claims can't be processed electronically within the
next four years. That single step would eliminate a mountain of
health care paperwork and pare back costs.
Fourth and finally, we will get the growth in federal health
programs under control. Right now, government health care
programs can claim a dubious distinction: they are the fastest
growing parts in the federal budget. / We must bring runaway
costs under control. We won't cut benefits. We won't raise
premiums. We can make real savings simply by reducing the rate
of increase.
pay for our
Efficiencies like this will help dur reform plan oprlect
Accepts. 11
The federal government should also give states the
flexibility to design new universal access programs for the poor
-- programs that will provide quality services to all their
citizens. States will be able to use new federal resources to
design programs that work -- not one-size-fits-a11 solutions
imposed by Washington.
Providing affordable care, efficient care, / wringing out
excess and waste and controlling federal growth: these four
points will create the kind of market-based reform plan that will
8
give Americans the kind of health care they want and deserve --
and put an end to the worry that keeps them awake at night.
Remember what people want. People want care they can afford
with cate they pan parys with them I and care they can count on.
I keep coming back to what works for this country. When we
talk about health care, we're talking about matters of the most
personal nature -- in some cases, literally, life and death
decisions. We don't need to put government between patients and
their doctors. We don't need to create another wasteful federal
bureaucracy. We need common sense. comprehensive health care
reform -- and we need it now. My four-point plan is the right
plan -- a plan that meets our obligation to all Americans by
putting hope and health within their reach. 11
Once again, my thanks for this warm Cleveland welcome. May
God bless the United States of America.
#
News Summary
OFFICE OF THE PRESS SECRETARY
THE WHITE HOUSE
WASHINGTON
fund
bite
of TUESDAY, Pves FEBRUARY responding- 4, 1992 -
6:00 A.M. EST EDITION
NATIONAL NEWS
Hum
DEMOCRATIC GOVERNORS, BUSH TANGLE ON BUDGET -- President Bush got
a rude awakening from Democratic governors Monday who interrupted
his pitch for his economic program to accuse him of budgetary
gimmicks, creating a "sewer of debt" and of favoring the rich.
Dan: let ии in sum we don 4 Five
(Washington Post, Boston Globe, Washington Times,
Wall Street Journal, New York Times, Chicago Tribune)
CRITICS POUNCE ON BUSH'S HEALTH PLAN IN ADVANCE President Bush's
expected proposal to squeeze Medicare and Medicaid to pay for
health insurance tax breaks is drawing outrage and ridicule even
before it is unveiled.
(AP, USA Today)
INTERNATIONAL NEWS
POWELL: SOVIET THREAT NOT ENTIRELY GONE -- In an effort to keep words
avoid there
defense cuts to President Bush's level, Gen. Powell is warning that
while the Commonwealth of Independent States does not now pose a
threat to world peace now, the situation could change.
(UPI)
PRIME MINISTER SAYS REMARKS NOT MEANT TO CRITICIZE AMERICANS --
Prime Minister Miyazawa scrambled Tuesday to control the diplomatic
damage done by his derogatory remarks about American workers,
saying he did not mean to impugn Americans.
(UPI)
NETWORK NEWS (Monday evening)
ECONOMY -- The economy and
politics were a particularly
combustible mix when
President Bush met with the
NATIONAL NEWS
A-1
nation's governors.
INTERNATIONAL NEWS
A-8
JAPAN -- The White House
said Japanese criticism of
NETWORK NEWS
B-1
American workers is "not
helpful."
EDITORIALS
C-1
BUCHANAN -- Patrick Buchanan
is trying to convince
conservatives that President
Bush has betrayed them.
This Summary is prepared Monday through Friday by the White House News Summary Staff.
For complete stories or information, please call 456-2950.
2451850.
&
- printmy only 70 tid bring
my prode printed
best brovate
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Alixe Blen
went wifs 3 rab on ump when 2. tel no
02.03.92 07:24 PM
PO1
DEPARTMENT OF HEALTH & HUMAN SERVICES
Office of the Secretary
Washington, D.C. 20201
FACSIMILE
PLEASE NOTIFY OR HAND-CARRY
THIS TRANSMISSION TO THE
FOLLOWING PERSON AS SOON AS
POSSIBLE:
Name:
Dan McGroarty
Address:
Telephone: a156-6218
Number of pages being transmitted (Including this one) 11
FROM:
alive
FAX NUMBER: (202) 245-5673
OFFICE NUMBER: (202) 245-1850
02.03.92 07:24 PM
P O 2
FOR RELEASE UPON DELIVERY
WEDNESDAY, JANUARY 22, 1992
*REMARKS BY
LOUIS W. SULLIVAN, M.D.
SECRETARY OF HEALTH AND HUMAN SERVICES
NATIONAL ASSOCIATION OF WHOLESALER-DISTRIBUTORS
WASHINGTON, D.C.
*TEXT IS THE BASIS OF SECRETARY SULLIVAN'S ORAL REMARKS.
IT SHOULD BE USED WITH THE UNDERSTANDING THAT SOME MATERIAL MAY
BE ADDED OR OMITTED DURING PRESENTATION.
02.
03.
92
07:24
PM
P03
As all of you have read or seen in media reports, President
Bush will soon unveil a comprehensive health care reform
proposal. Obviously, therefore, I am not in a position this
afternoon to detail what the President will say. But I can tell
you in general terms where this Administration is headed on
health care reform, so you can see that we are serious about
making comprehensive and fundamental improvements in our health
care system.
Health care reform is a complex task, not susceptible to
easy solutions. Clearly, members of NAW -- as founders of the
Health Equity Action League -- recognize the seriousness and
complexity of this challenge.
I want to be clear, up front, what this Administration's
mission is: to provide AFFORDABLE health care SECURITY for every
American, while maintaining the superior standards of our system.
We will not support such simplistic, cumbersome, bureaucratic
schemes as national health insurance or its precursor, "pay-or-
play," which promise universal access, but in reality, would
deliver access that is a mile wide and an inch deep in coverage
and timely availability.
1
02. 03. 92
07:24 PM
P 0 4
"Pay-or-play" should really be called "pay-and-pay-soms-
more." To take just one example: today, health care costs
consume 17 percent of Chrysler Corporation's payroll costs. The
bill before the Senate would let companies pay taxes of 7 or 9
percent of payroll, in lieu of direct coverage.
The compelling economics for Chrysler -- and all other
companies in a similar situation would be to move employees
into the new public system. But this begs the question: Would
the new public system ever be able to support itself at the level
of payroll tax proposed? Some estimate that an additional $36
billion would be needed. If we could not raise the taxes to pay
for this burden, we would quickly create a new inferior class of
health insurance for those in the public system.
America needs reforms that preserve quality of care, improve
access and control costs. This Administration's vision is of a
rising tide in American health care which lifts all ships, not of
one which would herd all citizens into an inadequate lifeboat.
This mission follows from three primary problems in our
current system:
2
02., 03. 92
07:24 PM
PO5
First, most Americans -- over 85 percent, in fact -- receive
the most advanced health care in the world. Under the
President's proposal, they will continue to do so, but will be
joined in this national legacy by their fellow citizens who are
currently outside the system -- most typically because they lack
health insurance, but also because health care simply may not be
readily available.
Second, it is also true that, of this 85 percent who have
access to the system, the cost of care and the security of access
to that care is increasingly troublesome. In a way, this
imperative for health care reform results from a paradox. The
very richness of health insurance that most Americans receive
insulates both them and health care providers from the true cost
of care.
In turn, this market distortion causes a racheting-up
of spending, and exacerbates the problem of access for those
without insurance, and affordablity for those with it.
Third, no matter what changes we finally make in our health
care system, very little improvement in the cost of care and the
health of our people will result until each of us takes greater
responsibility for our behavior.
From these root problems, numerous off-shoot dilemmas branch
out into the health care delivery system For example:
3
92
07
:
24
PM
PO6
As employers you must grapple with ballooning payroll costs
due to rising insurance premiums. This is becoming an
increasing burden on your ability to compete in the
marketplace.
At the same time, workers see their out-of-pocket health
care costs climbing, and the spending power of their
paychecks falling.
Self-employed persons -- or other workers not covered by an
employer-sponsored plan -- face the prospect of insurance
premiums simply beyond their ability to pay.
Insurers are hit with the effects of some businesses opting-
out of providing health care benefits because they can no
longer afford it. They feel the effects of cost-shifting by
providers trying to recoup for the significant amount of
care they give without compensation. Thus, they are forced
into intensified competition for low-risk policy holders,
and they avoid those who actually need insurance coverage.
4
02.
03.
92
07:24 PM
P07
o
Assure that employers do not lose their group coverage
because of an illness suffered by an employee or a
member of his or her family.
Choice
Yet, it is not enough merely to assure access, security and
affordablity; we must likewise assure choice. What has helped to
create the superior achievements of American medicine is the
absence of burdensome restrictions. We believe a system based in
private insurance will best preserve freedom of choice.
Requiring everyone to have the same benefit package, or making
government the czar of price setting and deciding what services
should be offered would be nothing short of a disaster.
Costs
The final imperative for our health care reform package is
real, long-lasting, self-sustaining cost containment. We do not
believe in artificial price controls. We believe in addressing
the root causes of cost inflation and changing the incentives in
the system to reward cost moderation. Our approach will, for
example, address:
o
Malpractice reforms;
o
Administrative costs in both the public and private
health insurance systems;
7
02.03.92 07:28 PM
P08
Access
We need to provide better ACCESS to health insurance, while
maintaining quality -- first, for unemployed Americans without
health care coverage to be able to obtain insurance; and second,
for those who are employed, to make health insurance more
needing
affordable to them and their employers, particularly small
businesses.
A corollary concern is that access to health insurance does
not automatically translate into access to health care. For the
children of the poor and near poor and those citizens living in
medically underserved rural and inner city areas, there is a need
for more readily available primary care.
Security
our second fundamental goal of providing security simply
means that we want to preserve what most people have - that no
one who has insurance will have to fear losing it because of
illness or job change.
We will seek to:
Assure that anyone with insurance can change a job
without losing coverage;
Prohibit excessive premium increases after a major
medical expense;
and, in a similar vein
6
02.
03.
92
07:28
PM
PO9
o
Assure that employers do not lose their group coverage
because of an illness suffered by an employee or a
member of his or her family.
Choice
Yet, it is not enough merely to assure access, security and
affordablity; we must likewise assure choice. What has helped to
create the superior achievements of American medicine is the
absence of burdensome restrictions. We believe a system based in
private insurance will best preserve freedom of choice.
Requiring everyone to have the same benefit package, or making
government the czar of price setting and deciding what services
should be offered would be nothing short of a disaster.
Costs
The final imperative for our health care reform package is
real, long-lasting, self-sustaining cost containment. We do not
believe in artificial price controls. We believe in addressing
the root causes of cost inflation and changing the incentives in
the system to reward cost moderation. Our approach will, for
example, address:
o
Malpractice reforms;
Administrative costs in both the public and private
health insurance systems;
7
02. 03. 92 07:28 PM
P10
o
Barriers to high quality, cost-effective coordinated
care for Medicaid and Medicare participants, and for
the broader public.
The use of more effective health care procedures
through effectiveness research; and
0
The importance of individual behavior.
Conclusion
The stakes involved in the health care debate have been
overly characterized in the media in political terms. In
reality, the stakes are much higher -- they embody what we hope
to become as a society.
The stakes include ideology and philosophy -- whether we
want to remain true of our commitment to choice and the private
sector in health care delivery, or run counter to our long
success with it -- and counter to the trend in the world today
- by starting down the muddy road of centralized planning.
The stakes also involve our economic well-being - whether
we can reduce the growing drain on our national finances and
still continue to provide quality care.
8
02. 03. 92 07:28 PM
P 1 1
And the stakes are societal - whether we can efficiently
provide a basic human need for all our citizens, or whether we
are going to have a growing chasm between the haves and the have-
nots in health care.
I applaud the National Association of Wholesalers for your
positive contribution to this debate, and I applaud each of you
for your involvement.
I invite your support when the President announces what you
will see as a sweeping, well considered reform of this country's
health care system.
####
9