Ask the Scholar

{
    "localId": "40488262",
    "label": "[HRC Speeches October - December 1993]: [Business Awards Luncheon 11/9/93]",
    "core": "doc",
    "dtoType": "document",
    "citationUrl": "https://catalog.archives.gov/id/40488262"
}

{
    "id": "40488262",
    "sourceUrl": "https://catalog.archives.gov/id/40488262",
    "contentType": "document",
    "title": "[HRC Speeches October - December 1993]: [Business Awards Luncheon 11/9/93]",
    "citationUrl": "https://catalog.archives.gov/id/40488262",
    "collections": [
        "Records of the First Lady's Office (Clinton Administration)",
        "Laura Schiller's Files"
    ],
    "iiifBase": "https://s3.amazonaws.com/NARAprodstorage/opastorage/live/62/4882/40488262/content/presidential-libraries/clinton/foia/2006/2006-1733-F/2006-1733-F-Laura-Schiller/Box_015/42-t-18546099-20061733F-015-012-2015/42_t_18546099_20061733F_015_012_2015_Page_001.JPG",
    "thumbnailUrl": "https://s3.amazonaws.com/NARAprodstorage/opastorage/live/62/4882/40488262/content/presidential-libraries/clinton/foia/2006/2006-1733-F/2006-1733-F-Laura-Schiller/Box_015/42-t-18546099-20061733F-015-012-2015/42_t_18546099_20061733F_015_012_2015_Page_001.JPG",
    "largeImageUrl": "https://s3.amazonaws.com/NARAprodstorage/opastorage/live/62/4882/40488262/content/presidential-libraries/clinton/foia/2006/2006-1733-F/2006-1733-F-Laura-Schiller/Box_015/42-t-18546099-20061733F-015-012-2015/42_t_18546099_20061733F_015_012_2015_Page_001.JPG",
    "imageCount": 21,
    "hasImages": true,
    "source": "import",
    "hasTranscription": false
}

{
    "url": "https://catalog.archives.gov/id/40488262",
    "naId": 40488262,
    "levelOfDescription": "fileUnit",
    "otherTitles": [
        "42-t-18546099-20061733F-015-012-2015"
    ],
    "recordType": "description",
    "ocrSource": "nara-archive"
}

{
    "seq": 21,
    "pageIndex": 0,
    "type": "document",
    "url": "https://s3.amazonaws.com/NARAprodstorage/opastorage/live/62/4882/40488262/content/presidential-libraries/clinton/foia/2006/2006-1733-F/2006-1733-F-PDF/Box_15/42-t-18546099-20061733F-015-012-2015.pdf",
    "mediaId": "39e59981a62e8f63",
    "ocrText": "FOIA Number: 2006-1733-F\nFOIA\nMARKER\nThis is not a textual record. This is used as an\nadministrative marker by the William J. Clinton\nPresidential Library Staff.\nCollection/Record Group:\nClinton Presidential Records\nSubgroup/Office of Origin:\nFirst Lady's Office\nSeries/Staff Member:\nSpeechwriting\nSubseries:\nLaura Schiller: HRC Speeches 1992 - 10/94\nOA/ID Number:\n24629\nFolderID:\nFolder Title:\n[HRC Speeches October - December 1993]: [Business Awards Luncheon 11/9/93]\nStack:\nRow:\nSection:\nShelf:\nPosition:\nS\n61\n2\n3\n1\nBusiness Awards 11-4\nTHE WHITE HOUSE\nOffice of the Press Secretary\nFor Immediate Release\nNovember 9, 1993\nREMARKS BY THE FIRST LADY\nBUSINESS AWARDS LUNCHEON\nA PARTICIPANT: -- Mr. Warren Buffet. (Applause)\nMR. BUFFET: After watching those stories, I think\nyou'll agree that they have created five very difficult acts\nto follow. And that's what we warned our next guest. She\nwasn't phased, of course. She has an uncanny ability to\nupstage some very important people.\nWe are thrilled to have with us today the First\nLady, Hillary Rodham Clinton, who passionately shares the\nvalues and visions that we have celebrating today. She will\nconclude our program with some reflections on the challenges\nfacing our country today, and the critical role that business\nmust play in meeting those challenges.\nLadies and gentlemen, First Lady, Hillary Rodham\nClinton.\n(Applause)\nMRS. CLINTON: Thank you very much. I believe this\nis the first after-breakfast speech I have ever given, and\nit's going to be mercifully short because there is very\nlittle that I think any of us can add to what we have already\nseen and learned this morning.\nWhen Warren and Jim and Norman came to see me some\nmonths ago to share with me really the vision of what this\ntrust is doing and hopes to do in the future, I was\nimmediately taken, as I always am, by the three of them,\nindividually or collectively, because they were, once again,\nseeing beyond where most of us can see.\nBut as I thought about what they were attempting to\ndo when they created this trust, and how we have seen how in\neach of these stories of the companies and individuals\nhonored this morning, that that vision is taking route and\nbeing exemplified, I was really moved by several thoughts.\nThe first is that this needs to be much more\nMORE\n2\nbroadly shared than among the group here. And I was\ndelighted to hear that the business schools of our country --\nI was a little concerned to hear that they are 200, but I was\ndelighted to hear that at least 200 business schools are\ngoing to be studying these videos and learning about the\nlessons from them.\nBut more than that, I was struck by how in so many\nways, with the collapse of many institutions in what used to\nbe called civil society, whether we talk about the church,\nwhether we talk about the kind of neighborhood, community,\ncivic organization, whether even we talk about the school or\nthe family, that in many ways you, who are in business, and\nits leaders, have responsibilities that were never\nenvisioned.\nEven I would guess, Diane, by the Merchants of\nLight.\nBecause for many Americans their contacts in the\nwork place, the lessons they learn there, the values that are\ntransmitted, may be the only ones that they are continually,\npersistently exposed to. That is something of a daunting\nrealization.\nBut if you think about how we spend our time now as\nindividuals, where we put our energies, it is true that\nrelationships and work, as was said before, can broadly\nsummarize. But there are no intermediary institutions, as\nthere used to be, playing the extraordinary roles that I\nthink many of us enjoyed in an earlier time as we came to\nmaturity.\nAnd at the bottom of every story we heard was a\nvery fundamental faith in the human potential and a\nwillingness to translate that faith into respect for the\nindividual. Whether we are talking about going into an inner\ncity, urban neighborhood to provide groceries to people who\nby and large work hard for a living, are too often\nstereotyped by the images we see, and who for the first time\nin years felt that they too had a right to be treated as the\nconsumers they are. That was respect.\nWhether it was recognizing that when illness and\ndifficult times strike, not turning one's back, but instead\nturning forward to face it, is a mark of courage as well as\ngood business, that too is respect. Seeing the men and women\nemployed in the building trades, and looking at their faces,\nand recognizing what it meant to them, both to be given as\nMORE\n3\nwomen, the opportunities that were extended, but also men who\nwere working, themselves, to figure out how to translate\nvalues into daily life, it was lessons in respect that made\nthat possible.\nAnd then the extraordinary images we saw of workers\non a shop floor being given information that for too long\nthey could only speculate about, and often speculate wrongly,\nbeing brought in as partners in an enterprise, being given\nthe tools so that they could become more fully involved in\nmaking the right decisions for themselves and their company,\nthat could only come because there was respect.\nAnd then, finally, the lifetime achievement given\nto someone who combined all of the extraordinary values we\nheard described, but really coming from a basic respect for a\nconstitution, for the institutions that are necessary for\nthis country to keep growing and meeting new challenges.\nSo there are many wonderful lessons. But these\nlessons have to be seen in the light of a time that demands\nthat they be applied more vigorously than ever before. We\nneed to clone and multiply the lessons and the leaders we\nhave seen this morning.\nThis country, as it confronts the 21st century,\nwill more and more listen to the words of business leaders.\nNot just because that is the way people make their livings,\nbut because of this new expanded role that you all are\nplaying in conveying values, not only to your employees and\nyour shareholders and those with whom you do business, but to\nthe larger society. Many of the great debates we are engaged\nin now are values debates. How we treat one another, how we\nsupport one another, how we hold one another responsible and\naccountable.\nAnd without adding more burdens to making a living,\nto making a profit, I hope that this trust can live up to its\nname by instilling in all of us a recognition that we have a\nlarger role to play in creating the environment that will not\nonly be good for business, but good for all of us in the\ncountry we love. Thank you very much. (Applause)\nA PARTICIPANT: I just want to offer our thanks to\nMrs. Clinton for being here for the honor of her presence,\nfor the honor of her words, and most of all thank you for the\nway you care.\nMORE\n4\nA couple of notes, quick notes. If you want to\nnominate someone for a business enterprise trust award, there\nare going to be forms out in the hall. There is going to be\na press conference here afterward, so unless you want to\nstay, leave fairly quickly so it can start. It's about the\ntrust awards. And, as Mrs. Clinton said, there's a year now\nto clone and multiply to become what Fitzgerald said we were,\nthat England was a land, France was a people, but America was\na willingness of the heart. See you next year. (Applause)\n* * * * *\nEXECUTIVE OFFICE OF THE PRESIDE\n02-Apr-1994 06:46pm\nTO:\nNicole R. Rabner\nTO:\nAlison Muscatine\nTO:\nElizabeth C. Bowyer\nFROM:\nKaren E. Finney\nOffice of the First Lady\nSUBJECT: Speech to HMO conference\nTHE WHITE HOUSE\nOffice of the Press Secretary\nFor Immediate Release\nFebruary 15,\n1994\nREMARKS OF THE FIRST LADY TO\nTHE 17TH ANNUAL HMO MANAGED CARE\nPOLICY CONFERENCE\nMRS. CLINTON: Thank you very much. Thank you.\nWell, I have to confess that I am glad to be home, but it was\nvery hard to leave. It was an exciting time, and I was very\nproud of our country and all the young people who were\ncompeting there. I will, like the rest of you, I will soon\nbe as a couch potato for the next two weeks as I watch the\nrest of the competition. It was an exciting opportunity.\nWe have another exciting opportunity in front of\nus. We have an opportunity to compete and win in the battle\nover health care reform. I am delighted to have this chance\nto speak with you because this organization and each of you\nrepresent some of the trends in health care reform that we\nare attempting to build on and that we believe hold the\ngreatest promise for the future of preserving what works in\nour American health care system but changing what doesn't and\nenhancing and building on the system that we all rely upon.\nMORE\nI want to begin by thanking you and thanking this\norganization for your cooperation with the Department of\nHealth and Human Services on the immunization drive. Karen\nhas just told me that something like 300 of the 350 members\nhave already agreed to participate in this immunization\neffort.\nAs someone who has fought for years to increase our\nimmunization rate, who has always been bewildered by the fact\nthat even in our hemisphere, countries much poorer than our\nown do a much better job reaching their young children, I am\nconfident that your assistance in this effort will make a\ngreat difference.\nI also am pleased that in a spirit of cooperation,\nyou are discussing the matters with HCFA and HHS that are of\nvital importance to you. That is the way this administration\nMORE\nlikes to work, prefers to work, bringing people around the\ntable and trying to solve problems. So I am grateful that on\nboth of those fronts you are involved.\nThis is an opportunity for me to talk with you\nabout those areas of agreement between the administration and\nthis association, to ask for your assistance in pushing those\nareas of agreement, and to talk about some of the other\nissues that lie before us as we work through these next\nmonths in our efforts to achieve universal health care for\nall Americans.\nThe President has been in Washington for only over\na year. Some days it feels closer to 100, but the calendar\nsays it's only one. We are pleased by many of the changes\nthat have been brought about, the feeling that I think many\nof us have that a lot of problems which had been denied or\nignored over previous years are finally being tackled, the\nsense that we are once again attempting to control our own\neconomic destiny, and that we are giving Americans a chance\nto compete and win in the global marketplace.\nThanks to the dedication of millions of Americans,\nwe do have progress to show. That was just the first year.\nTry to lay a foundation with things like the Family and\nMedical Leave Act so good workers can also be good parents,\nto expand the earned income tax credit to reward work over\nwelfare, to launch a new national service initiative and a\nnew student loan program that will help more young people\nfrom middle income families go to college and then to\nparticipate in rebuilding their community, to reduce the\ndeficit even more than we had projected, to expand trade with\nNAFTA and GATT.\nSo for many of us who believe that change was\nnecessary, this has been a very promising beginning to show\nthat drift and gridlock can be broken, that a new sense of\nrenewal and commitments can be engendered. We have a big\nagenda in front of us this year. We are going to be working\nvery hard to finalize a crime bill that will be real in the\nlives of Americans, that will put police on their streets,\nuse alternative punishment for first-time offenders like boot\ncamps, try to provide drug and alcohol treatment, try to make\nit possible for young people to have a chance to straighten\nout their lives, and to bring down the heaviest possible\npunishment on career violent criminals.\nWe will also be looking to move on the President's\npromise of welfare reform, which is inextricably bound with\nMORE\nhealth care reform. It is absolutely provable that millions\nof Americans are working every day without health care\nbenefits to provide taxes to pay for health benefits for\npeople on welfare. It is also true that many welfare\nrecipients choose to stay on welfare because to leave welfare\nand move into a minimum wage job without benefits doesn't\nseem like a very good trade.\nSo many of these issues are tied together, but\ncertainly there is none that is more important than health\ncare reform. How we handle that will tell a great deal about\nwhat we are as a nation at this point in our history. I have\nspent over a year now traveling around our country learning\nabout what is right with our health care system. I have seen\nmany people come to work for the groups represented here who\nare working hard every day as physicians, or nurses, or\nhospital administrators. I have listened to their stories. I\nhave looked into their eyes. I have come away impressed that\nthere isn't any doubt that we have the finest health care\nsystem in the world when it comes to delivering health care,\nbut that we have undercut our quality and our access by the\nway that we finance and organize much of the health care that\nis delivered.\nSo what we are attempting to do in the President's\napproach, the Health Security Act, is to take what works and\nbuilding on that to try to set into motion incentives that\nwill change those parts of our system that have proven to be\ninefficient and undermining of the quality of health care.\nThere are several parts to that, and it is\nespecially important to me that the administration and GHAA\nshare in common the following goals for health reform. These\ngoals, if they can be reached, will largely determine whether\nor not health care reform has been achieved. It is these\ngoals we ought to be keeping our minds focused on.\nThe first is universal coverage with comprehensive\nbenefits. Many people have asked me in the last several\nmonths what universal coverage means. That's not a term that\nis common in most American's language. What the President\nhas said repeatedly is that for him it means guaranteed\nprivate insurance. It means that the insurance available to\nall Americans will always be there, will not be taken away,\nwill not contain lifetime limits, will not be offered on the\nbasis of preexisting conditions or age as a device for rating\ninsurance to be more expensive for some Americans than for\nMORE\nothers.\nThe only real way to determine if we have achieved\nhealth care reform is to know how we will be able to\nguarantee that every American does have that private\ninsurance. Often I'm asked, \" well, what else does the\nPresident really believe is important?\" Well, he believes\nmany things are important, but his bottom line is\nguaranteeing private insurance.\nNow, what does that really mean? It means that\nthere has to be some mechanism in place for financing\nuniversal coverage for guaranteed private insurance. There\nare only three ways to do that. The first is that you can,\nas many countries have, raise a big tax and use it to replace\nany private sector investments, and to have the government\nbasically run the health care system. Sometimes it's\nreferred to as a single payer system.\nThat is an option that the President rejected. It\nis one of the more inaccurate claims made by some who say\nthat the President's plan is a government plan. The\nPresident's plan is a mixed plan, as our system is today.\nMedicare in the government program, there will still be those\nwho are among the very poorest who will be subsidized. There\nwill still be public health facilities. By and large, most\nAmericans will receive their insurance the way they do now,\nthrough their employers.\nSo, if you do not raise a large tax, then what is\nleft for alternatives to achieve universal coverage? There\nare only two. One is referred to as the individual mandate.\nThe individual mandate would require individuals to go into\nthe marketplace, assuming a reformed marketplace or at least\na subsidized marketplace, to purchase their own insurance.\nThis at least recognizes that in the absence of some mandate\n-- on the one hand, either a tax, which is an obvious\nmandate, or on the other, an individual or, as we would\npropose it, an employer/employee requirement, that there has\nto be some requirement for everyone to get into the system in\norder for universal coverage to be achieved and cost shifting\nto cease.\nThe individual mandate, therefore, at least\nrecognizes that absolute precondition for universal coverage.\nWhat it does, unfortunately, is create some additional\nproblems, at least as we analyze them. It makes it very\nMORE\ndifficult to determine and monitor who is in the system and\nwho is out. It would require tracking individuals as they\nmoved in and out of jobs, as they move in and out of the\ninsurance market, and it would, if you provided a subsidy\nscheme to support low wage individuals, a determination as to\nwhen their income reached some arbitrary level as to what\nkind of subsidy they would still be entitled to. It would\nrequire and argue the IRS to engage in an enormous\nadministrative oversight of our health care system.\nIt would also lead to the very unfortunate\ncircumstances of having a cut off for the subsidies. So\nthat, say, everyone below 200 percent of poverty with an\nindividual mandate would receive some sliding scale subsidy.\nWhat, then, do we do with those at 201 percent? What do we\ndo with the low wage workers who currently receive some or\nall health care benefits through their employers? Wouldn't\nemployers, looking at this rationally, say to themselves if I\nam currently paying benefits for this population group and\nnow the government will subsidize them. I will drop them\nfrom my benefits packages, therefore increasing the pool of\nworkers who would therefore require subsidy, a very difficult\ntask, in our view, to both project the cost of and to keep up\nwith administratively.\nThe only examples we have of individual mandates\nare those like auto insurance requirements in many states\nwhere in spite of the fact that the state has access to all\ndrivers through the licensing process, literally thousands\nand even hundreds of thousands of drivers remain uninsured in\nstates with such an individual mandate.\nIf you do not want, therefore, a state financed\nhealth care system, and if the individual mandate poses the\nkind of administrative and equity and cost issues that we\nbelieve it does, then from our perspective the sensible\napproach is to build on the employer/employee system that\nalready serves 100 million Americans.\nIf you look at what is possible in terms of\nsubsidizing businesses at a rate that would be joined to\ntheir employment level so that the smaller they were the more\nlow wage workers they employed, the larger the subsidy or the\ndiscounts they would receive, it is a much easier\nadministrative task to keep track of those businesses which\nalready process other government requirements, such as the\ntax which pays for medicare.\nMORE\nIf you have a reformed insurance market in which\ncosts are brought down through the use of pools of\npurchasers, whether they're called alliances or HIPCs\n(phonetic), or whatever one calls them, so that small\nbusinesses and solo entrepreneurs can compete for the same\ncost of health insurance with the largest businesses, then\nthe discounts become a relatively stable investment in the\nwhole health care system.\nIf you believe, as the first principle of this\nassociation states, in universal coverage, then I hope you\nwill help us with the employer mandate. The employer mandate\nis the key to achieving universal coverage. Without the\nemployer mandate, we will continue to tinker around the edges\nand not provide universal coverage.\nThe second part of this goal is comprehensive\nbenefits. The President's plan is one of the few that\noutlines the benefits. A number of the competing\nalternatives talk about creating a national board that will,\nat a future date, determine the health care benefits.\nThis strikes us as the wrong approach for at least\ntwo reasons. The first is that legislatively and politically\nit seems difficult to explain to the American people that\nCongress would have passed a piece of legislation that\npromises you insurance but doesn't tell you what you're\nbuying. The second is that in the absence of determining\nwhat the benefits are, it is impossible to assign any\nactuarial value and then to determine what subsidies or\ndiscounts in any approach one would choose would have to be.\nSo, for both the political and the substantive\nreasons, we think the better course is to determine on the\nfront end what the health care benefits should be to\nestablish a national board that in the future would review\npossible additions or exclusions as we gain more experience,\nbut that we have to, in good faith with the millions of\nAmericans who currently have insurance, be able to tell them\nwhat health care reform would mean to them with respect to a\ncomprehensive, standardized package of benefits.\nIf you share our belief that we should be setting\nthe benefits, even if you might disagree with what those\nbenefits should consist of, I hope, again, you will express\nyour opinions about doing that. It would strike me that it\nwould be impossible for you to sell your packages of benefits\nMORE\nif you didn't list them, if the way you tried to market to\nyour consumers was to say trust us, we're the greatest HMO in\nthe region, you buy, we'll tell you later what your benefits\nare. That's, in a sense, what many of these members of\nCongress want the American public to do with health care\nreform legislation.\nYour second goal, the elimination of preexisting\nconditions exclusions, is one that we share completely. We\nwould add to it that we would also eliminate lifetime limits\nand eliminate experience ratings based upon age. The third\ngoal, the annual open enrollment, is part of the President's\nplan. The fourth, that it would be patient choice of plan,\nis very important to the President's approach.\nA number of the other alternative offer the\npossibility of enrollment but with penalties. If you do not\nenroll in the lowest cost plan in an area or if you do not\nenroll in the lowest cost in the lower third of the plan in\nthe area, then your employer and you lose whatever tax\npreference you would otherwise be entitled to.\nWe have a difficult time, again, figuring out what\nwill be the mechanism for determining in 50 states and\nliterally hundreds of regions what is the lowest cost plan on\na year-to-year basis. If you are selling a plan that\nprovides more preventive health because you really believe in\nit, and one of your competitors is selling a plan which\nclaims to provide preventive health, but if you read the\nsmall print, it doesn't provide as much as you do, but\nthey're able to offer it at five dollars less a month, then\nyour potential customers are going to say to you, \"if I\nchoose your plan, I lose my tax preference. I'm going to use\nyour competitor's plan.\"\nYou're going to say, \" but we're not comparing\napples to apples. We're comparing apples to oranges. We\nthink we've got the lowest cost plan for the benefits that\nwill be provided.\" They're going to say well, \"all I know\nis the law has said I'm going to lose my preference and on\npaper, the other is the lowest cost plan. I can't take a\nchance.\" Who will arbitrate that? Who will make that\ndetermination?\nWe think there is tremendous danger in the kinds of\ncomparisons, and the monitorings, and accountability, and\ngaming that will occur if we try to finance health care\nMORE\nreform by removing tax preferences and pushing everybody into\nso-called low cost plans when, for millions of consumers,\nthey're not going to be able to make the difference. Many of\nyou will be forced to make decisions that you don't think are\nnecessarily in your customer's best interest to try to fall\nunder some arbitrary line that has been established in a\npiece of legislation. We think this is one of the most\ndangerous and threatening aspects to health care reform.\nSo we would argue strongly that patient choice of\nplan should mean just that. You compete, as you are now\ndoing, on price and quality. You offer the comprehensive\nbenefits package however you best can present it. A customer\nof yours, because your charges are slightly higher than a\ncompetitor's, even though you think you are delivering better\nquality, is free to make that decision without tax penalty.\nThe final goal which we share is quality reporting.\nThis is key to everything we hope to be able to do in health\ncare reform. In the President's plan, there will be some new\nrequirements for quality reporting, but they are similar to\nwhat you as an association and you individually have already\nbegun to do.\nIt will be important if we expect consumers to make\ncost conscious decisions for them to have good quality\ninformation. We want to use linkages between providers of\ncare such as youth, and academic health centers, and teaching\nhospitals, and the government at both the federal and state\nlevel both to collect but more importantly to translate and\nprovide in easily acceptable terminology information about\nquality. So when those open enrollment periods come, each\nconsumer feels comfortable making the choice that they think\nbest fits their families.\nNow, if one takes each of those goals on which we\nalready agreed, there is an enormous amount that can be\naccomplished if we could achieve just those. For us,\nuniversal coverage with comprehensive benefits is the most\nimportant part of health care reform, more important than\nmany of the other details that are going to take an enormous\namount of time and energy in the American political scene in\nthe next several months as people argue and debate over them.\nIf we do not honestly acknowledge that the only way\nwe can achieve universal coverage is by having some kind of\nrequired financing mechanism, then everything else we do, no\nMORE\nmatter how it is described, will fall short of what should be\nthe minimum achievement this year with health care reform.\nI want to mention just a few things about some\nissues that we need to work through together and that I hope\nyou will be part of an ongoing consultation and advisory\ngroup with us, because what we believe will best help the\nAmerican people and begin to dampen the rhetoric, cut through\nthe ideology, and spend our time looking for ways that will\nactually lead us to a consensus.\nI know that many of you are concerned by the kinds\nof charges and attacks that have been made of managed care in\nthe last several months. In fact, the ads that have been run\nover the last months against the President's Health Security\nAct, which have introduced us to Harry and Louise, are a\npretty unveiled attack on managed care. It's not very\nsubtle, is it? In fact, that has been one of the primary\ndevices used by the opponents of health care reform in\ngeneral.\nMake no mistake, many of those who are attacking\nthis plan on the basis of the failures or the alleged\nfailures of managed care, they try to have it all ways. On\nthe one hand, we're going to try to push everybody into\nmanaged care. On the other hand, we're going to have the\ngovernment run it. It makes no logical sense, but those are\ntwo emotional hot buttons that keep being pressed.\nWhat the idea behind that often is is that no\nreform and no change is what the real agenda happens to be. I\nthink we have to acknowledge that. One of the ways to do\nthat is to get out good information about the successes of\nmanaged care and to be honest about the problems that exist\nthat your organizations are working to overcome.\nYou know that there are those who believe that\nthere's an accepted reliance on gate keepers, that there is\nwhat is often called heavy-handed utilization review\ntechniques, and that there are restrictions in providing\npatients with opportunity to see physicians outside the HMO.\nFor all of those criticisms, there are many\npositive trends that you can point to that you should be\ntrumpeting much more effectively than I think is currently\nhappening, because the positive trend far outweighs the\nnegative problem.\nMORE\nWe know, for example, that the fastest growing\nmanaged care systems are those that are giving patients more\nchoice and more opportunities to see physicians outside the\nHMO network. That should be something that you talk about.\nWe also know that the increasing reliance on team work,\nimproving the cooperation and communication between nurses,\nand primary care physicians, and specialists, and hospitals\nare really producing positive results. Programs in your\norganization recognize that cost control require a parallel\ncommitment to better health outcomes and ongoing quality\nimprovements.\nSo if you can recognize what are the kinds of\nattacks that are aimed at managed care for what they are, a\ndesire to obstruct and derail reform period and to maintain\nwherever possible the status quo, including a status quo that\nundermines many of the innovations that you have tried to\nbring to the health care market, then you will have a very\nstrong voice in trying to reason effectively both with the\nCongress and with the American public.\nThere should be, in my view, advertisements running\nthat show the high level of satisfaction in most HMOs, that\nwhat you are doing is providing health care that people are\nfeeling more and more comfortable with, that they're moving\ninto at faster and faster numbers because they recognize the\nkind of management that you provide is useful to them.\nThis cuts across all demographics. Many of the\nexperiments in managed care for Medicaid patients that some\nof your organizations are involved in are having excellent\nresults. Some, as you know, are not. We need to be honest\nabout talking about the successes and the disappointments but\nshowing how in this very fast moving industry you are part\nof, you are learning every day from the problems and\ndifficulties of trying to provide better care in a managed\nenvironment for all of your patients.\nYour policies emphasizing preventive care are ones\nthat Americans agree with overwhelmingly. Many Americans\ndon't know that that's one of the real hallmarks for managed\ncare. Managed care, as you know better than I, has real\nregional appeal in some regions and is practically off the\nradar screen and not existent in other regions. One of our\nchallenges will be talking with members of Congress from\nstates other than places like California or Washington about\nmanaged care. They won't believe the TV advertisements\nMORE\nunless you are aggressive in telling them what managed care\nreally can --\nSo part of what I would ask you to do today is in\nthe months ahead to be a voice for effective quality managed\ncare, to talk about what you are achieving, to acknowledge\nhonestly your problems. I don't believe in papering over any\npiece of reality when it comes to this. There's too much at\nstake.\nMany of you have learned over the years how to deal\nwith even those problems effectively, to use a gate keeper as\na gate opener, for example, to expand preventive care further\nand further year by year, such as this immunization effort,\nto make managed care attractive to the Medicare population so\nthat they too see the advantages.\nThat's a story you have to tell because even though\nthe numbers of millions of American who are in some way\ninvolved in managed care look very impressive, it is still a\nlargely regional phenomenon that you have to help us then\nspread the word to other parts of the country.\nThere will be differences as we move through this\nabout alliance size and alliance authority and discrimination\nand the other things that you have raised about that. There\nwill also be issues about how to get effective cost\ncontainment, whether premium caps are a good idea, whether\nthey are or they aren't, what other devices could be used to\ntry to make sure that when we start pumping billions of\ndollars more into the health care system, that we will get\nour money's worth.\nProbably one of the biggest myths of all is that\nwe're going to, in some way, begin to cut into the basic\nhealth care when, in fact, if you add all the currently\nuninsured with their employer/employee contribution, you are\ntalking about an increase of about 50 billion dollars. You\nare talking about moving our GDP percentage spent on health\ncare from approximately 14-and-a-half to 17-and-a-half\npercent. We are talking about putting a lot more money into\nour health care system, and we try to get savings out of it.\nSo in order for that money to be well spent in the\neyes of those who eventually pay the bills, whether they be\nbusinesses or individuals or government, there has to be some\nkind of cost containment structure built in. But those are\nMORE\nissues that we are open to discussing with you. We will need\nyour help and we want your help.\nI think you know, as well as those who worked on\nthe administration's plan, that in the absence of real health\ncare reform, what will probably happen is something along the\nlines of this scenario: increasing budgetary pressures will\nforce further and further cuts in the rate of increase in\nMedicare and Medicaid, the downward pressure on the crisis in\nthose government programs will put at further risk many of\nthe facilities that you rely on, many of the physicians that\nare part of your networks, which will, in turn, create\ngreater incentives for cost shifting.\nThe continuing downward pressure on benefits and\nlayoffs from the largest corporations will leave more and\nmore Americans uninsured or underinsured, which will push\nthem into seeking care later, often at the most expensive\npoint of entry, the emergency room, which will create even\nfurther incentives to shift cost onto the backs of the\nprimary payers who are still basically funding the system.\nThe vicious cycle of those falling into the public\nprograms that will pay less and less, making it more and more\ndifficult even for you to shift costs elsewhere, will only\naccelerate. We will therefore be spending more and more on\nless and less health care.\nFor those who think there has been a respite from\nthe inexorable price increases, those kinds of economic\nscenarios starting with budget pressures at the federal and\nstate governments on the public programs will explode\nwhatever price restraints have been achieved in the last year\nor two. That doesn't have to happen and it won't happen if\nyou help give leadership to what you know works in providing\nhealth care.\nDon't underestimate how difficult it will be\nbecause we've been down this road before. Democratic and\nRepublican presidents since Franklin Roosevelt have tried to\nachieve universal health care and they were unable to do it;\nRoosevelt and then Harry Truman, Johnson with Medicare and\nMedicaid which took care of the very poorest and our elderly,\nRichard Nixon with a program that is remarkably like the one\nthat the president is proposing, building on the\nemployer/employee system, and Jimmy Carter, others, have\ntried.\nMORE\nI think that the pressures today, both for economic\nreasons and moral or ethical reasons, are going to overcome\nthe political opposition. But we want to be sure we do this\nright. In order to accomplish that, we need to combine\nwisdom and experience of your association and each of your\nindividual organizations.\nWe want you to be partners in ensuring that finally\nAmericans have health security and can feel good about having\ntheir needs met in a reformed health care system. Thank you\nvery much.\n* * * * *\nMORE"
}