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"IF WE DO NOTHING" DATA --
National Governors Association Speech
The President's unwavering commitment to universal coverage is about providing middle-
class, working Americans with the health security they and their families deserve. Working
Americans are losing this security today - their coverage is being dropped, their benefits
are being cut, and they spend more each year to pay for people who have no insurance.
Without reform, this will only get worse - the same health care will cost more every year
even as workers lose wages to rising health costs.
MORE AND MORE COMPANIES WILL DROP THE INSURANCE THEY NOW OFFER:
From 1988 to 1992, the percentage of workers who were covered by their company's health plan
dropped from 81% to 78%. [Department of Labor, 5/94]
The percentage of families who received full employer-paid medical coverage fell from 32% in 1988
to 19% in 1992. [Hay/Huggins Benefits Report, 1992]
The high cost of insurance is expected to cause 30% of small businesses currently providing
insurance to drop coverage in the years ahead. This will further raise premiums for the smallest
companies that do provide. [Health Affairs, Spring 1992]
Because of the rising costs of health care, only 15 percent of new companies offered health
benefits to their employees in 1992, compared to 23 percent in 1978. One and a half million
fewer full-time workers receive health benefits directly through an employer today, compared
to 1988. [Ken Thorpe, University of North Carolina, 8/92]
FACED WITH RISING COSTS, EMPLOYERS WILL CONTINUE TO CUT BENEFITS:
Nearly 6 in 10 of those earning $30,000 to $50,000 a year had some experience in their
household with cutbacks in health benefits in recent years. [New York Times/CBS News Poll,
4/7/93]
The percentage of families who received fully employer-paid medical coverage fell from
32% in 1988 to 19% in 1992. [Hay Huggins Benefits Report, 1992]
Only 43% of health care plans offered full hospital coverage in 1992 -- compared with 54%
in 1988. [Hay Huggins Benefits Report, 1992]
The number of companies offering normal retiree medical benefits has dropped from 72% in
1988 to 57% in 1992. [Hay Huggins Benefits Report, 1992]
FAMILIES WILL PAY MORE
From 1988 to 1993, the average family premium for employer-based group health insurance
doubled, from $2,500 to $5,200. Families wanting to buy health insurance directly from an
insurer can spend as much as $10,000 a year. [HIAA (1988) and KPMG Peat Marwick (1993) in New
York Times, 6/12/94]
From 1988 to 1993, individual premiums for employer-based group health insurance by
almost 70%, from $1,200 to $2,000. [HIAA (1988) and KPMG Peat Marwick (1993) in New York
Times, 6/12/94]
PEOPLE WILL CONTINUE TO LOSE WAGES TO PAY FOR HEALTH CARE:
If health care had been reformed in 1975, American workers would have over $1,000 in extra
wages each year. [Commerce Department, Office of Management and Budget]
The amount of total compensation going to health care keeps growing -- by 1993, an average of
$1.10 of each worker's hourly wages went to pay for health insurance, up from 92 cents just two
years before. Without reform, workers will lose another $600 per year in wages by the year 2000.
[HHS, 6/94; OMB]
AMERICANS WILL CONTINUE TO LOSE THEIR HEALTH CHOICES:
From 1988 to 1993, the percentage of people enrolled by their employer in traditional fee-
for-service health plans -- which allow them to see any doctor they choose -- plummeted to
49% from 71%. [KPMG Peat Marwick in Wall Street Journal, 2/10/94]
THE DEFICIT REDUCTION WE'VE FOUGHT FOR WILL BE WASTED:
If we do nothing, health care spending will rise from 14% of GDP today to an astonishing
18% of GDP in the year 2000 -- meaning that seven years from today, almost $1 out of
every $5 earned by Americans will go to health spending. [OMB]
More than half of the expected $295 billion increase in federal revenue between 1996 and
2000 will be absorbed by health care cost increases. ["The Economic and Budget Outlook", CBQ,
1/94]
MORE AND MORE STATE DOLLARS WILL BE DIVERTED TO HEALTH CARE:
In the last three years alone, state Medicaid expenditures have spiraled as a percentage of
state budgets -- from just over 8 percent in 1990 to 12 percent in 1993. [HHS calculations from
National Association of State Budget Officers data]
State Medicaid expenditures are projected to consume nearly 18 percent of state budgets in
the year 2000 -- twice as much as they had just ten years before. [HHS calculations from National
Association of State Budget Officers data]
In 1993, for the first time in history, states spent more on health care than they did on tax-
financed higher education. [National Association of State Legislators]
WHAT WILL HAPPEN TO AMERICA IF WE FAIL TO ENACT UNIVERSAL
HEALTH CARE REFORM
Data based on comparison of the status quo and effects of the Health Security Act
now
22,232,601 Americans who work for a living will be denied health care protection.
now
7,797,780 of America's children will be left out in the cold.
and
American businesses that currently offer insurance will pay an estimated $59 billion
more in premium costs, an average of $605 per worker.
American workers employed by firms that offer insurance will pay an estimated $28
billion more for insurance, an average of $293 per worker ($24/month).
American workers will lose an estimated $47 billion in wages, an average of $484
per worker.
America will continue to lose $25 billion in uncompensated care each year.
States will pay $45.8 billion more on health care by the year 2000.
States will pay $19 billion more in Medicaid expenditures.
31,848,000 privately insured Americans under 65 will be denied prescription
drug coverage.
now
120,553,000 privately insured Americans will go without dental benefits.
153,199,000 privately insured Americans will be denied mental health and
substance abuse benefits.
2,607,000 Americans with disabilities will be unable to get the home and
community-based care benefits they need.
81,082,475 Americans can still be denied health insurance or forced to pay
higher rates due to pre-existing conditions.
2,248,000 Americans will continue to lose their health insurance each month.
18,517,000 of America's Medicare recipients will not gain prescription drug
coverage.
PUTTING PEOPLE FIRST
Putting People First: A Strategy for Change
will fully fund programs that save us several dollars for
national apprenticeship-style system that offers non-col-
every one we spend-Head Start; the Women, Infants
lege-bound students training in valuable skills, with the
and Children (WIC) program; and other critical initia-
promise of good jobs when they graduate.
tives recommended by the National Commission on
Children.
National Service Trust Fund. To give every American
the right to borrow money for college, we will retain the
Dramatically Improve K-12 Education. We will over-
Pell grant program but scrap the existing student loan
haul America's public schools to ensure that every child
program and establish a National Service Trust Fund.
has a chance for a world-class education. We will establish
Those who borrow from the fund will be able to choose
tough standards and a national examination system in
how to repay the balance: either as a small percentage of
core subjects like math and science, level the playing field
their earnings over time, or by serving their communities
for disadvantaged students, and reduce class sizes. Every
doing work their country needs as teachers, law enforce-
parent should have the right to choose the public school
ment officers, health-care workers, or peer counselors
his or her child attends, as they do in Arkansas. In return,
helping kids stay off drugs and in school.
we will demand that parents work with their children to
Worker Retraining. We will require every employer to
keep them in school, off drugs, and headed toward gradu-
spend 1.5 percent of payroll for continuing education and
ation.
training, and make them provide the training to all work-
ers, not just executives. Workers will be able to choose
Safe Schools Initiative. We will provide funds for vio-
advanced skills training, the chance to earn a high school
lence-ridden schools to hire security personnel and pur-
diploma, or the opportunity to learn to read. And we will
chase metal detectors, and we will help cities and states
streamline the confusing array of publicly funded training
use community policing to put more police officers on the
streets in high-crime areas where schools are located.
programs.
Youth Opportunity Corps. To give teenagers who drop
AFFORDABLE QUALITY HEALTH CARE
out of school a second chance, we will help communities
open youth centers. Teenagers will be matched with
The American health-care system costs too much and
adults who care about them and given a chance to de-
does not work. Instead of putting people first, Washing-
velop self-discipline and skills.
ton favors the insurance companies, drug manufacturers,
and health-care bureaucracies. We cannot build tomor-
National Apprenticeship Program We will bring busi-
row's economy until we guarantee every American the
ness, labor, and education leaders together to develop a
right to affordable quality health care.
18
19
PUTTING PEOPLE FIRST
Putting People First: A Strategy for Change
Washington has ignored the needs of middle-class fam-
need are leaders who are willing to take on the insurance
ilies and let health-care costs soar out of control. Ameri-
companies, the drug companies, and the health-care
can drug companies have raised their prices three times
bureaucracies and bring health-care costs down.
faster than the rate of inflation, forcing American con-
Our health-care plan is simple in concept but revolu-
sumers to pay up to six times more than Canadians or
tionary in scope. First, we will move to radically control
Europeans pay for the same drugs. Insurance companies
costs by changing incentives, reducing paperwork, and
routinely deny coverage to consumers with "pre-existing
cracking down on drug and insurance company practices.
conditions" and waste billions on bureaucracy and admin-
As costs drop, we will phase in guaranteed universal access
istration. Twelve years ago, Americans spent $249 billion
to basic medical coverage through employer or public
on health care. This year we'll spend more than $800
programs.
billion.
Companies will be required to insure their employees,
Health-care costs are now the number one cause of
with federal assistance in the early years to help them
bankruptcy and labor disputes. They threaten our ability
meet their obligations. Health-care providers will finally
to compete, adding, for example, $700 to the cost of every
have incentives to reduce costs and improve quality for
car made in America. Our complex system chokes con-
consumers. Savings from cost containment will help those
sumers and providers with paper, requiring the average
who pay too much for health insurance today. American
doctor to spend eighty hours a month on paperwork. It
health care will make sense.
invites fraud and abuse. We spend more on health care
Our plan will put people first by guaranteeing quality,
than any nation on earth and don't get our money's
affordable health care. No American will go without
worth.
health care, but in return everyone who can must share
Our people still live in fear. Today almost 60 million
the cost of his or her care. The main elements include:
Americans have inadequate health insurance-or none at
all. Every year working men and women are forced to pay
National Spending Caps. The cost of health care must
more while their employers cover less. Small businesses
not be allowed to rise faster than the average American's
are caught between going broke and doing right by their
income. We will scrap the Health Care Financing Ad-
employees. Infants die at rates that exceed countries
ministration and replace it with a health standards
blessed with far fewer resources. Across our nation older
board-made up of consumers, providers, business, labor,
Americans live in fear that they will fall ill-and lose
and government-that will establish annual health bud-
everything or bankrupt their children's dreams trying to
get targets and outline a core benefits package.
pay for the care they deserve.
America has the potential to provide the world's best,
Universal Coverage. Affordable quality health care will
most advanced and cost-effective health care. What we
be a right, not a privilege. Under our plan, employers and
20
21
PUTTING PEOPLE FIRST
Putting People First: A Strategy for Change
employees will either purchase private insurance or opt to
personal medical information. We will also crack down
buy into a high-quality public program. Every American
on billing fraud and remove incentives that invite abuse.
not covered by an employer will receive the core benefits
package set by the health standards board.
A Rational Medical Liability System. To reduce litiga-
tion costs and keep doctors from practicing "defensive
Managed Care Networks. Consumers will have access to
medicine," we will help develop alternative dispute-reso-
a variety of local health networks, made up of insurers,
lution mechanisms in every state. These procedures will
hospitals, clinics, and doctors. The networks will receive
effectively and humanely resolve legal challenges.
a fixed amount of money for each consumer, giving them
the necessary incentive to control costs.
Core Benefits Package. Every American will be guaran-
teed a basic health benefits package that includes ambula-
Eliminating Drug Price Gouging. To protect American
tory physician care, inpatient hospital care, prescription
consumers and bring down prescription drug prices, we
drugs, and basic mental health care. The package will
will eliminate tax breaks for drug companies that raise
allow consumers to choose where to receive care and will
their prices faster than Americans' incomes rise.
include expanded preventive treatments such as pre-natal
care, mammograms, and routine health screenings. We'll
Taking on the Insurance Industry. To stand up to the
provide more services to the elderly and the disabled by
powerful insurance lobby and stop consumers from pay-
expanding Medicare to include more long-term care.
ing billions in administrative waste, we need to streamline
the industry. Our health plan will institute a single claim
Equitable Costs. We will protect small businesses
form and ban underwriting practices that waste billions
through "community rating," which requires insurers to
to discover which patients are bad risks. Any insurance
spread risk evenly among all companies.
company that wants to do business will have to take all
comers and charge every business in a community the
same rate. No company will be able to deny coverage to
A REVOLUTION IN GOVERNMENT
individuals with pre-existing conditions.
We cannot put people first and create jobs and economic
Fighting Bureaucracy and Billing Fraud. To control
growth without a revolution in government. We must
costs and trim the "paper hospital," our plan will replace
take away power from the entrenched bureaucracies and
expensive and complex financial forms and accounting
special interests that dominate Washington.
procedures with a simplified, streamlined billing system.
We can no longer afford to pay more for-and get less
All Americans will carry "smart cards" coded with their
from-our government. The answer for every problem
22
23
AFFORDABLE QUALITY HEALTH CARE
This section of Putting People First promises to "radically control [health] costs by changing
incentives, reducing paperwork and cracking down on drug and insurance company practices."
The plan commits to put a lid on soaring health costs, "phase-in guaranteed universal access
to basic medical coverage through employer or public programs," increase use of managed
care, fight bureaucracy and billing fraud, and provide small business access to the same prices
available only to large purchasers today.
The Health Security Act, proposed by the President on September 23, 1993, met, with only
the most minor of exceptions, every health care pledge made in Putting People First. The
plan dramatically reduced the rising cost of health care through increased competition and
caps on rising premium costs. It reached universal coverage for all Americans by 1997, with
a requirement that all employers contribute to the health premiums of their employees. It
guaranteed prescription drug coverage for all Americans and limited the ability of insurance
companies to compete only on risk, not price and quality. And it guaranteed individuals
access to managed care networks and small business access -- through community rating ---
to the same premium prices as large businesses.
The Health Security Act progressed farther in the Congress than any comprehensive health
reform initiative ever had before. It was reported out by four Committees and made it to the
Senate floor for the beginning of an historical debate. Although the Congress did not
complete action on health reform in 1994, the Administrations all-out effort has put this vital
issue at the top of the American domestic priority agenda. Despite an unprecedented
misinformation campaign by the opponents of health reform, the two-year debate has made
the public and the Congress better informed about health care and the choices we have before
us. As a result, even as we enter the 104th Congress with a Republican-controlled House
and Senate, every Member of Congress is fully aware that the problems of our current health
care system will not disappear and can and must be addressed.
42.
Commitment: National Spending Caps. The cost of health care must not be
allowed to rise faster than the average American's income. I will scrap the
Health Care Financing Administration and replace it with a health standards
board -- made up of consumers, providers, business, labor and government -- -
- that will establish annual health budget targets and outline a core benefits
package.
Assessment: Legislation Proposed
Background: On January 25, 1993, the President announced the formation of the
Health Care Task Force, which would design health care legislation that would provide
guaranteed health insurance for all Americans. On September 23, 1994, the President
submitted the Health Security Act for consideration by Congress.
51
Section 6001 of the Health Security Act called for premium caps, which, by 1999,
would hold the rate of growth on health insurance premiums to growth in CPI. To the
extend that real average income growth is positive, holding health care growth to CPI
would meet the President's promise of capping the cost of health care growth at or
below income growth.
While the Health Care Financing Administration (HCFA) would continue to exist even
under the Health Security Act, Section 1501 of the Act called for the establishment of
a National Health Board (which would exist along with HCFA). The National Health
Board would be comprised of members "selected on the basis of their experience and
expertise in relevant subjects, such as the practice of medicine, nursing or other
clinical practices, health care financing and delivery, state health systems, consumer
protection, business, law and delivery of care to vulnerable populations." The one
group not mentioned in the legislation but mentioned in Putting People First is labor.
As promised in the campaign, the Board would be responsible for interpreting and
recommending changes to the comprehensive benefits package and overseeing cost
containment provisions of the Act in addition to other duties.
43.
Commitment: Universal coverage. Affordable, quality health care will be a right,
not a privilege. Under my plan, employers and employees will either purchase
private insurance or opt to buy into a high-quality public program. Every
American not covered by an employer will receive the core benefit package set by
the health standards board.
Assessment: Legislation Proposed
Background: Title I, Subtitles A & B of the Health Security Act describe the health
care coverage to which all eligible individuals -- citizens, legal aliens, and long-term
non-immigrants -- are entitled and date on which coverage becomes effective.
Section 1322 of the HSA guarantees that each alliance would offer residents a choice
of health plans among those that have contracts with the alliance, including choice of a
fee for service plan. This will provide consumers with the best opportunity to obtain
affordable, quality health care.
Section 1002 requires eligible individuals to enroll in a private health insurance plan
and pay the required portion of premiums.
Section 6121 of the HSA requires each employer to pay 80 percent of premiums for
each employee.
52
Section 1001 (d) entitles Medicare - eligible individuals to benefits through the
Medicare program rather than through the Health Security Act.
Title V, Subtitle A of the HSA establishes various programs, councils, surveys and
standards to ensure quality health care services.
44.
Commitment: Managed Care Networks. Consumers will have access to a variety
of local health networks, made up of insurers, hospitals, clinics and doctors. The
networks will receive a fixed amount of money for each consumer, giving them
the necessary incentives to control costs.
Assessment: Legislation Proposed
Background: Section 1321 requires alliances to negotiate with any willing state-
certified health plan to enroll eligible individuals. Section 1322 (a) ensures that each
alliance offer residents a choice of health plans among those that have contracts with
the alliance. Alliances are expected to offer: fee for service plans, preferred provider
organizations (PPO), and health maintenance organizations (HMO), but must at least
include a fee-for-service option. Both the PPO and the HMO options are managed
care options, which include hospitals, clinics and doctors. These plans are paid a fixed
amount of money for each enrollee, which i expected to give them incentives to
control costs.
Section 1322 (d) of HSA allows regional alliances to use prospective budgeting in
creating its fee schedule. This would force large providers of health care to budget
their resources and watch costs more closely.
Section 4011 encourages managed care under the Medicare program through uniform
open enrollment periods for risk-sharing plans. This would enable more people to
shop around for the policy that provides high quality services at a low cost.
43.
45.
Commitment: Eliminate Drug Price Gouging. To protect American consumers
and bring down prescription drug prices, I will eliminate tax breaks for drug
companies that raise their prices faster than American's incomes rise.
Assessment: Partial Accomplishment
Background: On February 17, 1993, the President submitted A Vision of Change for
America to Congress which contained initiatives to curb prescription drug prices. On
April 8, 1993 the President presented the Administration's FY 1994 Budget to
Congress which detailed the specific steps to be taken. On August 10, 1993, the
President signed into law the Omnibus Budget Reconciliation Act (OBRA) of 1993.
53
"Investing in the Future: Reducing the Deficit to Increase Private Investment," a
chapter in A Vision of Change for America, called for a reassessment of the extremely
costly tax incentives provided in Puerto Rico. The initiative called for tax incentives
available to American corporations, including many pharmaceutical firms, in Puerto
Rico to be capped at 65 percent of compensation paid to workers in Puerto Rico.
Section 936 of OBRA limited tax credits available to drug companies to either 40% of
credit available under prior law (when fully phased in)n or 60% of compensation plus
a portion of depreciation expense. This tax change will generate almost $4 billion in
savings between FY 1994 and FY 1998.
Section 2001 of HSA amends the Social Security Act to add outpatient drugs to
Medicare benefits. This would help to protect older Americans from paying
unreasonable amounts for medically necessary drugs. Medicare beneficiaries would
have 80 percent coverage for their medications after a $250 deductible is reached.
Section 2003 requires manufacturers of drug products to rebate part of their Medicare
sales to the Secretary of Health and Human Services. The rebate mechanism was
established to provide an incentive for manufacturers to keep prices at reasonable
levels.
Section 1572 provides for an Advisory Council on Breakthrough Drugs which would
examine the reasonableness of new drug pricing in the case of drugs that represent a
breakthrough or significant advance over existing therapies.
As a result of Administration focus on the high cost of prescription drugs, 17
pharmaceutical industry executives, representing two-thirds of the US pharmaceutical
market, agreed to hold price increases at or below the general inflation rate. To the
extent that real average income growth is positive, holding drug prices to CPI would
meet the President's promise of keeping drug price inflation at or below income
growth.
46.
Commitment: Take on the Insurance Industry. To stand up to the powerful
insurance lobby and stop consumers from paying billions in administrative waste,
we need to streamline the industry. My health plan will institute a single claim
form and ban underwriting practices that waste billions to discover which
patients are bad risks. Any insurance company that wants to do business will
have to take all comers and charge every business in a community the same rate.
No company will be able to deny coverage to individuals with preexisting
conditions.
Assessment: Legislation Proposed
54
Background: Section 5130 of the Health Security Act requires that the National
Health Board develop standardized forms for insurance companies, including a single
claims form.
Section 1402 of the Health Security Act requires heal plans to accept every eligible
person seeking enrollment and bans plans from engaging in underwriting practices that
help seek out the best risks. The section also prohibits plans from denying coverage
for preexisting conditions.
Section 1403 of the Health Security Act requires plans to charge everyone in a region
a community rate that can only differ by type of family.
47.
Commitment: Fight bureaucracy and billing fraud. To control costs and trim the
"paper hospital," my plan will replace expensive and complex financial forms and
accounting procedures with a simplified, streamlined billing system. Everyone
will carry "smart cards" coded with their personal medical information. We will
also crack down on billing fraud and remove incentives that invite abuse.
Assessment: Legislation Proposed
Background: As noted above, Section 5130 of HSA provides for claims form
simplification that will produce a streamlined billing system.
Section 5105 requires the National Health Board to issue Health Security Cards to
obtain benefits. These cards would contain information about the identity of the card-
holder, the applicable health plan in which the individual is enrolled, supplemental
policies which the individual maintains, and other information the Board determines is
necessary.
Section 5104 through 5441 provide for fraud and abuse programs, funds, and penalties
to curb illegal activities. These activities would involve the Secretary of Health and
Human Services, the Attorney General, and the Inspector General of the Department
of Health and Human Services.
48.
Commitment: Core benefits package. Every American will be guaranteed a basic
health benefits package that includes ambulatory physician care, inpatient
hospital care, prescription drugs, and basic mental health. The package will
allow consumers to choose where to receive care and include expanded preventive
treatments such as pre-natal care, mammograms and routine health screening.
We'll provide more services to the elderly and the disabled by expanding
Medicare to include more long-term care.
55
Assessment: Legislation Proposed
Background: Section 1101 of HSA sets forth a comprehensive basic benefits package
which health plans must provide for all enrollees. This package includes ambulatory
medical and surgical services, hospital services, prescription drugs and mental health
services as well as substances abuse, family planning, hospice, home health care,
ambulance, vision, dental, and outpatient laboratory, radiology and diagnostic services.
Section 1322 (a) ensures that each alliance offer residents a choice of health plans
among those that have contracts with the alliance.
Preventive services such as pre-natal care, mammogram, and routine health screening
are also provided for in Section 1101 of HSA.
Section 2101 of HSA creates a new state entitlement to Federal payments for home
and community-based services and related activities for individuals with disabilities.
Section 4221 amends the Medicaid statute to specify that all Medicaid enrollees are
eligible to receive long term care services covered under their state's medicaid plan.
Section 7701 provides for the expansion of services eligible for deductibility of long-
term care expenses incurred by an incapacitated individual. Under this rule, the entire
cost of services provided in a nursing home or similar institution may be a medical
expense if the principal purpose of the individual's presence is the availability of
medical care at the institution.
49.
Commitment: Equitable cost. We will protect small businesses through
"community rating, "which requires insurers to spread risk evenly among all
companies.
Assessment: Legislation Proposed
Background: Section 1403 of the Health Security Act requires plans to charge
everyone in a region a community rate that can only differ by type of family. This is
achieved through regional alliances which spread risk across a large group of people
rather than concentrate it within a small business. This would make costs more
equitable across employers.
56
NATIONAL SERVICE
The History
When President Clinton signed his national service legislation into law on September 21,
1993, he used pens that Presidents Roosevelt and Kennedy had used to sign past acts. It was
fitting. Clinton had drawn on the efforts of these past Presidents for his program. And national
service is an idea with roots deep in American history.
Across two centuries of vast changes, a spirit of service has helped to sustain America. Our
nation was founded by citizens who risked everything to build a foundation for freedom. "A debt
of service," said Thomas Jefferson, "is owed by every [citizen] to [our] country." In the 19th
century, the richness and diversity of America's civic life stunned foreign observers. Alexis de
Tocqueville found that in America as nowhere else, people consistently helped people--lending
a hand to neighbors, making a difference in the community. And from the American Revolution
to the Civil Rights Revolution, that kind of citizenship has helped to bring about great
improvements in American life.
Programs of service organized at the national level have always built on this rich tradition.
In a 1910 essay, William James argued for creating an army of young people to tackle domestic
problems and restore their civic spirit in "the moral equivalent of war." During the Great
Depression, Franklin D. Roosevelt created the first great national service program, the Civilian
Conservation Corps (CCC). Four million young people joined--restoring the nation's parks,
revitalizing our economy, and supporting their families and themselves. Through its eleven years,
the CCC provided $XX billion in services and enabled millions of families to live in dignity. It
was one of the New Deal's proudest successes.
A generation later, President Kennedy created the Peace Corps as the concrete embodiment
of his most famous words: "Ask not what your country can do for you, ask what you can do for
your country." Responding to that call then and in the years since, thousands of Peace Corps
Volunteers have left he comforts of home and traveled to the poorest corners of the globe,
building schools where none existed, helping farmers feed the hungry, and creating hospitals to
care for the sic. After meeting vital needs overseas, returned Peace Corps Volunteers have
brought their expertise and commitment back home to America.
The Vision
In developing a program of national service for a new generation, President Clinton has
drawn on two vital principles from these programs. First, service is important because there is
a lot of work to do right now in America. We have too many unmet needs, and our taxpayers'
money is too precious, to create a new program for youths to rake leaves and pick up gum
wrappers. If national service is about anything, it has to be about doing real work-- ensuring
immunizations for infants, teaching children to read, making neighborhoods healthy for families,
and keeping the elderly safe in their homes.
Second, a new program of national service should aim to strengthen the spirit of citizenship.
Too often today, young people speak about rights, but not about responsibilities. Yet an ethic
of entitlement without obligation doesn't work-and it's certainly not what has always made
America great. A program of national service can help restore balance to our civic life. It shows
those who serve, and those who don't, that Americans can--and should-give back to their
communities and country.
In return for their contribution to our country, those who serve ought to get something in
return for themselves. This is the principle of reciprocity: more opportunity in return for more
responsibility. And for young people near the beginning of their careers-the age of most who
participate-there is no greater source of opportunity than education. Those who help our country
can get an award to help pay for their education. This idea first received strong emphasis in the
Democratic Leadership Council's vision of national service, strongly articulated beginning in 1988
by Senators Sam Nunn, Chuck Robb, Barbara Mikulski, and then-Governor Bill Clinton.
The model here is the GI Bill. Through the GI Bill, millions of Americans have attended
college, helping themselves and contributing to America's productivity at the same time. In an
era when college costs have risen dramatically, national service can offer a new way for young
people willing to give a helping hand to others to get a hand up for themselves.
A final important principle behind national service harkens back to the Civil Rights
Movement. While its great victories eliminated many barriers in the law, they didn't bring down
all the walls that wrongly divide Americans from each other. If our country is to move ahead,
citizens of every race, region, and religion have to be able to work together. The military has
long provided an important place for Americans of all backgrounds to mix. With downsizing at
the end of the Cold War, it's now as important as ever to find places where Americans can come
together in common work. National service is one of those places--a place for common ground.
The Initiative
During the 1992 campaign, the pledge to create a "domestic Peace Corps" excited as much
interest as any proposal. Like 30 years before, young people were especially energized; in the
first 100 days, the White House was flooded with thousands of postcards and phone calls about
the shape of the new program. On the 100th day of his Administration, President Clinton
detailed his program to fulfill that campaign promise, and by the end of his second year in office,
more people were participating in the new effort than in the Peace Corps at its largest.
Designed with bipartisan support in the Congress and from the Governors, President Clinton's
new program--AmeriCorps--is simple enough. Anyone over age 17 may participate, although
in practice most Members of AmeriCorps are young people. Members agree to make a
significant commitment to service--either a year or two full-time, or a longer period, part-time.
Through their service, they meet important needs: improving our schools, housing the homeless,
and making our streets safe and our environment clean. In return for their service, they earn a
small stipend and, at the end of their service, an education award worth about $5,000 per term--
nearly the average cost of a year at a four-year, public university. The education award can be
used to repay existing loans or to pay for current or future expenses at any accredited four-year,
two-year, or vocational institution.
As the first program of its kind in a generation, AmeriCorps had to reflect the cutting-edge
of reinventing government. And it does. The Corporation for National Service--a combination
of existing agencies, not a new one-oversees the effort. The Corporation sets broad standards,
tracks cost-effectiveness, and monitors progress toward basic goals. But the real power is in the
2
hands of states and communities, each of which design unique programs to meet their own
specific needs. Happily, AmeriCorps doesn't have to reinvent the wheel: instead, it's building on
a massive network of existing efforts are already meeting local needs. These programs have
already tapped into the energy of young people who want to contribute, and of communities that
are struggling to meet their own needs. AmeriCorps becomes a powerful engine of change, with
parts as diverse as America itself. The only watchword in every program is "getting things
done"--meeting the real needs of America's communities.
Today, in more than 400 AmeriCorps programs around the country, nearly 20,000 Americans
are serving America. They are from every state in the union and every background under the
sun. What they share is a commitment to helping themselves and improving our country. And
that's exactly what they are doing-- getting things done, not with the heavy hand of government,
but with the helping hand of service. Today, AmeriCorps Members are saving babies in south
Texas and raising reading scores in Seattle; they're walking the NYPD beat in Brooklyn and
patrolling Balboa Park in San Diego; they're taking seniors safely to the doctor in St. Louis and
keeping kids out of gangs in Killen, Texas; they're building new homes in Roxbury,
Massachusetts, and helping parents teach their children in Auburn, Mississippi.
Everywhere they go, AmeriCorps Members are getting results. That south Texas program
began in the summer of 1993 and catalyzed the state's first immunization outreach campaign--
leading to the immunization of more than 104,000 children in eight weeks. Texas has now
expanded that program, and others are following suit. With hard work, scores of other
AmeriCorps programs can provide equally inspiring models for change. And AmeriCorps can
expand to provide opportunities for service to thousands more American young people.
[Case study: AmeriCorps Cadet Program]
A unique partnership among the New York City Police Department (NYPD), the John Jay
College of Criminal Justice, and the Corporation for National Service, AmeriCorps Cadets
enables young people to fight crime in their communities and become police officers themselves.
The xxx-year Cadet term is similar to the Reserve Officer Training Corps (and the Police Corps,
discussed elsewhere). During the school-year, Cadets attend classes full-time, including those
of the police academy, and serve with the NYPD part-time. During the summer, they serve full-
time in their communities. On completing both their college education and their AmeriCorps
experience, the Cadets become sworn police officers.
The AmeriCorps Cadets program builds on the existing Cadet program of the NYPD, but it
adds an especially strong commitment to community-based problem-solving, using insights from
the community policing movement. Teams of six to eight cadets are assigned to 15 of the
highest crime precincts in New York City. There, they work with police officers and community
members to address specific problems. Projects include reducing "quality-of-life crimes" in
Lower Manhattan by cutting loitering and drug and alcohol violations; establishing a "Safe
Corridor" for commuting schoolchildren in mid-Manhattan; taking back a drug-infested block
in East Harlem by recruiting blockwatchers, enlisting landlords, and coordinating patrols;
patrolling parks across Brooklyn to report and reduce crimes; and more.
During the 1994 "Summer of Safety," a pilot for the AmeriCorps program, the first one-
hundred AmeriCorps Cadets made striking advances against crime in New York City. The
3
positive accomplishments are many, but the most striking element is one thing that didn't happen:
for the first summer in memory, there were no sexual assaults reported at New York City's public
swimming pools, thanks to AmeriCorps Cadet patrols there. All 100 SOS Cadets, as diverse as
New York City itself, have re-enrolled this year.
[Case study: David Trevino]
When David Trevino sees teachers send children to the corner for bad behavior, he tells
himself, "That was me." After David's parents split up when he was seven years old, his interest
in learning dried up. Teachers believed he was learning disabled and placed him in special
education classes. In an example of the "tyranny of low expectations," David recalls teachers
telling him he "wasn't going to make it." For a long time, David believed them and scored
poorly.
The turning point in David Trevino's life was when a fourth grade teacher took a special
interest in him and taught him, for the first time, to enjoy learning and to believe in his abilities.
David graduated from high school and went on to attend Austin Community College, where he
is currently a sophomore. Still inspired by his old teacher's example, David has become a teacher
himself, too, as part of the AmeriCorps for Math and Literacy program in Austin, Texas. There,
David teaches basic skills--reading, writing, and math--to disadvantaged children-the kinds
of children he once was.
David is passionate about giving back the caring and inspiration given to him in his
childhood. He says his goal this year is to change as many lives as he can. One life he is sure
to change is his own. David will use his education award next year when he transfers to the
University of Texas to begin pursuing a degree in environmental studies with a concentration in
water quality.
[Quotes: Bill Clinton on service]
"National service will be America at its best: building community, offering opportunity, and
rewarding responsibility. National service is a challenge for Americans from every background
and walk of life [It] is nothing less than the American way to change America."
"The lesson of our whole history is that honoring service and rewarding responsibility is the best
investment America can make."
"National service recognizes a simple but powerful truth, that we make progress not by
governmental action alone, but we do best when the people and their government work at the
grassroots in genuine partnership."
"I believe that national service will remain throughout the life of America not a series of
promises, but a series of challenges, across all the generations and all walks of life, to help us
to rebuild our troubled but wonderful land."
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"But beyond the concrete achievements of AmeriCorps, beyond the expanded educational
opportunities those achievements will earn, national service, I hope and pray, will help us to
strengthen the cords that bind us together as a people-- will help us to remember in the quiet
of every night, that what each of us can become is to some extent determined by whether all of
us can become what God meant us to be.
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Dec 06 94 12:28 No. 003 P.02
To: Kim O'Neill, Gene Sperling
From: Walter Zelman
Attached is draft of chapter on health care. It is actually
written as a brief history of the reform effort. I have,
obviously, tried to offer a positive rendition, but with as little
spin as possible.
I'm happy to revise or rework it should that be requested.
Please let me know how the project progresses.
Also, as you read through the document, you will note some
remarks in parenthethis, where something may need to be added, or
where a date may need to be checked. I don't have all the
information I needed here.
I can get you the disk if you want it.
W
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Dec 06 94 12:28 No 003 P.03
DRAFT DRAFT DRAFT DRAFT
THE CLINTON ADMINISTRATION AND HEALTH CARE
I. THE HEALTH CARE CRISIS
As the United States entered the 1990's it faced a serious and
worsening health care crisis. The nation was the world's leader in
medical technology, maintained and supported the world's greatest
medical training facilities, and delivered the highest quality care
to many of its citizens. But in several critical respects the
system was clearly failing.
We remained the only industrialized nation, other than
South Africa, that did not guarantee basic health care to
all its citizens. Over 35 million Americans (about 15%
of the population) had no insurance coverage. And that
percentage was growing each year.
Health care was absorbing an ever-increasing percentage
of our gross domestic product (about 14% in 1992, going
up to an anticipated 18% by the turn of the century).
Health care spending --defined either in terms of
national health care expenditures or in terms of
insurance premiums-- was growing at double digit rates,
3 to four times the rate of inflation. This unchecked
growth was undermining the nation's capacity to invest in
other economic sectors and rendering health care costs
increasingly unaffordable for families, employers, and
governments.
The nation's system of employer-based, private insurance
was clearly broken. Millions of Americans were
subjected to pre-existing condition exclusions that kept
them from receiving required care. (In an absurd twist
of fate, that which should be treated first, would be
treated last, or not at all). Loss of a job or a
serious illness could render almost any American
uninsured and sometimes uninsurable. Employers and
employees would pay radically different insurance
premiums depending the age, sex, or health status of the
employer group with which they happened to be associated.
Yearly premium increases of 15% or more were commonplace.
Small businesses continued to be particularly hard hit,
with employers and their employees routinely paying
considerably higher premiums for less coverage.
Additionally, they were particularly subject to sudden
premium increases, or cancellations depending on the
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experience of just one or two members of group.
And while the nation retained an unequaled capacity to
deliver the highest quality care, we lagged far behind
other nations on in the delivery of basic preventive
care. Disproportionate numbers of the uninsured were
children.
The crisis, it must be emphasized, was one faced by all
Americans. While the uninsured were disproportionately lower
income Americans, an estimated 80% of them were workers or their
dependents. About one-third of uninsured Americans were in
families earning over 200% of poverty. As stories of Americans
losing insurance became nightly features on the evening news, and
as soaring costs began forcing workers and employers to choose
between maintaining benefits and maintaining salary levels, the
nation realized that its health care crisis was a middle class
crisis that effected all. All were but one job or one illness from
having no health insurance for themselves or their families.
II. THE SEARCH FOR A SOLUTION LEADS TO DEADLOCK
In the early 1990's the health care crisis was not new. It
had been worsening for some time. Literally dozens of reform
proposals had been offered by analysts, organizations and
legislators of every conceivable political stripe.
But while some modest progress had been achieved at the state
level, discussions at the federal government level remained almost
hopelessly deadlocked.
That deadlock had both partisan and genuine philosophical
underpinnings. In general, Democrats advocated universal coverage,
a requirement that all contribute (generally through an employer
mandate) and aggressive cost control. Almost inevitably, it
seemed, their proposals were marked by heavy doses government
direction and regulation.
Republicans, for their part, did not object to the concept of
universal coverage. But since they opposed mandates to pay and
favored market-oriented over government directed solutions, they
objected to mandates and government directed cost control. As a
result, their proposals could not achieve universal coverage or
promise reductions in cost.
With the Congress in Democratic hands and George Bush in the
White House, hope for compromise was virtually non-existent. In
spite of the obvious crisis, and in spite of increasing demands for
reform, no serious movement towards reform was even attempted. It
was all too clear, that the two sides could not agree.
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III. THE CLINTON CAMPAIGN; SEEKING A CONSENSUS
Throughout the primary season of 1992, and through the
Democratic convention in July, then-Governor Bill Clinton wrestled
with the health care reform issue. As first, in the early months
of the campaign he advocated traditional Democratic approaches,
featuring universal coverage via and employer mandate and the so-
called "play or pay" approach in which employers would either
purchase insurance (play) for their employees or pay to have them
insured though a public program.
The campaign document, Putting People First, reflected the
candidates general views on the need for reform. The proposal
committed the candidate to "control (health) costs by changing
incentives, reducing paperwork and cracking down on drug and
insurance company practices." Additionally, there was an expressed
commitment to "phase-in guaranteed universal access to basic
medical coverage through employer or public programs," to increase
the use of lower-cost managed care, and to provide small businesses
access to the same premium charges available to larger purchasers.
Putting People First reflected the candidates general
preference for market over regulatory forces. But as the campaign
moved into the late summer and fall, the candidate felt a need to
define that preference in more specific terms. In particular, he
sought a reform policy that would move away from a potential heavy
reliance on publicly-delivered care. Additionally, he was
uncomfortable with the rate-regulation that would be likely to
accompany large public programs. He preferred to guarantee
coverage through an expansions of private insurance. In short, he
sought a means of achieving traditional Democratic goals of
universal coverage and cost containment without the government
oriented, government-run systems that seemed so dominant in most
proposals that approached that goal.
At the Governor's prodding, his health care advisors worked
throughout the summer of 1992 to fashion an alternative approach.
The resulting proposal was outlined by the Governor in a speech at
on September 23. In that speech the Governor called for an
expansion of coverage and reductions in costs through competition
between private health insurance plans. The approach was known
generally as managed competition --an appropriate term, which
called attention to the blending of competitive and regulatory
(management) approaches to reform. The Governor maintained his
support for an employer mandate, but made it clear that employer
and employee dollars should fund private, not publicly delivered
health care.
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IV. DETAILING A PROPOSAL: A HEALTH CARE TASK FORCE
Immediately upon assuming the Presidency, President Clinton
appointed a task force of high level Administration appointees, to
be chaired by the First Lady. He charged it with developing a
comprehensive reform proposal, based on the policies he had
outlined during the campaign.
The task force and its working groups would soon become
controversial, accused of meeting in secret and of allowing access
to special interest groups. The implication of the charges made
was that some were given special treatment and access by being
included in the process, while most were denied the opportunity to
provide input.
Whatever may have been the value of such a large working group
both charges were inaccurate. Members of the task force and
working groups met with dozens of groups throughout the policy
formulation process. And while many of the 500 or so individuals
who participated in working groups had various different political
leanings and associations great efforts were made to make certain
that all participants were government employees at the time and
that none represented particular interests with a strong and
specific special interest in task force outcomes.
In the end, what was truly unusual about the process was not
the secrecy in which the working groups operated, but the numbers
of individuals involved. President's have every right to develop
policy via private discussions and working groups of government
employees and do so all the time. What was unusual here was that
so many individuals were involved. Ironically, the decision to
involve hundreds, rather than handfuls, left the process with an
appearance not of inclusion, but of exclusion. Had the President
asked 20 government employees to retire to a conference room to
meet meet privately for 5 months until they had formulated policy
recommendations, the process would have been considered customary
and would have encountered little public comment or criticism.
But 500 participants was another story. While well-
intentioned, then, the combination of project size and privacy
proved to be a matter of some public concern, and enabled some
opponents of reform to use criticism of the process to help
undermine the substance that that process would ultimately produce.
The task force and its working groups, in consultation with
the President and many Cabinet members produced the Health Security
Act. The President outlined the principles underlying the Act in
a speech to the nation on September 23. He further detailed those
principles in a speech given upon presentation of the legislation
to the Congress, (October
1993) and in his State of the Union
address on
of 1994.
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While the Health Security Act provided a detailed reform road
map, the President's presentation of his reform plan and of the
health care crisis in general continued to focus on principles
rather than details. The President continued to assert that his
Administration would remain flexible on virtually all elements of
the proposal, and that he would work with others to seek consensus
around a proposal that could win widespread Congressional and
public support. There was only one principle, he declared, on
which he would not compromise: universal coverage, a guarantee of
health care for all Americans. In his State of the Union speech he
threatened to veto any proposal that did not achieve that goal.
V. THE HEALTH SECURITY ACT
The Health Security Act was, without question, a comprehensive
and sweeping reform proposal. Among other things, it called for:
Universal coverage, to be phased in over several
years. through enrollment of individuals and families in
private health insurance plans.
Financing of that coverage by: (1) a requirement that
employers contribute to the health insurance of their
employees and their families; (2) a requirement that all
Americans have health insurance and contribute to its
cost (if employers choose not to pay the full cost) (3)
government assistance to families and specified employers
for whom the costs of insurance would be too great a
burden.
Creation of a comprehensive benefits package that would
be offered by all insurers.
Reduction of insurance costs by: (1) increasing
competition between private insurance plans (rather than
regulation) ; (2) eliminating administrative inefficiency;
(3) increasing the choices and power of insurance
consumers; and (4) a back-up mechanism for limiting the
rate of growth in insurance premiums. Competition in the
new system would be based on price, quality and service,
rather than on an insurers ability to avoid enrolling
high cost individuals.
Creation of large purchasing pools to increase consumer
choice and information about different insurance plans,
and to give smaller business and individuals the same
purchasing power (and thus the same rates) as large
employers.
Insurance market reforms, including: community rating
(charging all the same regardless of age, sex, occupation
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or health status); a guarantee that all insurers would
enroll anyone who wished to enroll in their plans; and
elimination of pre-existing condition exclusions.
Enhancement of the Medicare benefits package to include
prescription drugs.
Measures to monitor and improve the quality of health
care, and to better enable consumers to compare health
insurance plans on quality.
Phased in implementation of a new home and community-
based long-term care program.
Privatization of most of the Medicaid program, with most
Medicaid recipients being mainstreamed into private
health insurance plans.
Reforms in medical education that would encourage the
training of more primary care physicians.
Improvements in the delivery of preventive care,
including the building of preventive care into the
guaranteed benefits package.
Government financing of subsidies through an increase in
the tobacco tax, reductions in spending the Medicare and
Medicaid programs, and increased tax revenues as
employers spent less on (tax deductible) health care
costs.
VI. CONGRESS CONSIDERS THE HEALTH SECURITY ACT
During 1994 five Congressional committees (three in the House
and two in the Senate) considered large portions of the HSA.
Countless hearings were held. Public input --from interest groups
of all kinds-- was extensive. As had been expected, each committee
retained portions of the President's specific proposal, while
changing, adding or deleting other elements.
But by late June (check date, might have been early or mid
July) four of the five committees had reported comprehensive reform
bills. (The exception was the House Energy and Commerce Committee,
which deadlocked, largely over provisions that employers be
required to contribute). Three of the four reporting committees
produced bills that met the President's goal of universal coverage.
(The Senate Finance Committee bill fell somewhat short of that
goal).
Senate Majority Leader George Mitchell and House Majority
Leader Richard Gephardt, then took the competing drafts and
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produced two reform bills -both of which would achieve universal
coverage-- for presentation to the floors of their respective
houses.
It was the first time that comprehensive health care reform
legislation had progressed to that stage.
But reform would go no further. The House, waiting for the
Senate to act, never debated the Gephardt proposal. The Senate
debated the Mitchell bill for several weeks, but never voted on
the full proposal. Senator Mitchell sought compromise with a so-
called "Mainstream Group," which had produced a more modest reform
proposal. But that effort, too, came up short. In mid (?)
September Mitchell gave up the effort.
VII. ASSESSING THE CAUSES OF FAILURE TO APPROVE REFORM
The President's reform effort drew widespread support from
organizations of all kinds. Support from senior citizens groups,
consumer groups, and labor groups might, all things considered,
have been expected. But support also came from many organizations
of health care professionals --physicians, hospitals, social
workers and psychologists, nurses, medical school deans and heads
of teaching hospitals. An organization of small businesses (gas
station owners, small retailers, pharmacies, etc.) that formed to
support reform reached (get number form OPL) members. Many of
America's largest employers supported the reform effort as well.
And at the outset of the debate so, too, did the American
public. In September of 1993
% responded that they supported
the President's plan. (check numbers and what they supported).
But the opposition --led by some organizations of small
businesses, many insurers, and supported by some major
organizations of large employers) would prove formidable-- and
capable of expending greater amounts to make its case.
In the end, there was no one explanation for the failure to
approve comprehensive reform. But a few explanations stand out.
These include.
The ability of those opposing reform --especially
elements of the insurance industry and organizations of
small businesses-- to convince the public that the
President was proposing a giant, bureaucratic,
government-run health care plan.
Admittedly, the plan was very broad in scope, and that
breadth may have helped opponents in applying the "big
government" label. But the President's plan was hardly
the "big government" outlined by opponents. Repeatedly,
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the President emphasized the goal of private, not public,
insurance for all. And as the debate progressed in
Congress the new quasi-government entity, the mandatory
purchasing cooperative, was dropped in favor of a
voluntary cooperative, in most proposals. Still, the big
government label stuck.
Massive spending by the opposition on ads and other media
efforts that gradually undermined public support for
going forward. If nothing else, the massive negative
campaign added to public uncertainty and insecurity
regarding reform.
That the ads were effective could not be questioned. But
it is equally clear that what they undermined was support
for the image of the "Clinton plan" not the plan itself,
and certainly not the plan as it was evolving in the
Congressional process. In a telling headline (date) the
Wall Street Journal proclaimed that "Public Doesn't Know
it, but its the Clinton plan they like." (Get exact
wording) The article detailed polling results showing
public opposition to the "Clinton Plan," but strong
support for virtually all its positions.
As the economy improved, and as the news media reported
declining rates of interest in health insurance premiums,
the sense of crisis that had accompanied the introduction
of the plan diminished. As the debate wore on,
opposition groups, including most Republicans in
Congress, began to argue effectively, that the nation
could afford to go slow, to wait until next year.
Sophisticated Congressional observers knew that "wait
until next year," meant start all over again and do
little or nothing. But the argument carried weight with
the general public.
Increasing partisanship as the end of the Congressional
session drew near. With the public --subject as it was
to endless negative messages-- rendered more uncertain,
Republican opponents grew bolder in their opposition to
reform. Whereas in 1993 many had supported universal
coverage, and some form of mandate to achieve it, in the
summer and fall of 1994 they backed away from those
proposals. Even as the President took criticism on his
left flank for endorsing proposals that might not cover
100% of Americans, Republicans moved further to the
right, asserting that we should "wait," move step-by-
step, or make only minor reform adjustments.
Finally, it must be noted that, in the American political
environment, reform efforts --indeed all efforts to
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promote change-- start from a disadvantaged position.
The American legislative system was constructed to move
incrementally. Change must overcome numerous committee
hurdles, and different majorities in House and Senate.
Moreover, in modern times, reform efforts must also
overcome the inevitable opposition of status-quo
supporting, powerful interest groups and the highly
sophisticated techniques those groups can employ to
produce negative reactions from a skeptical American
public. Defeating change, in short, is far easier than
achieving it.
In the end, some consensus might have been achieved around
incremental, insurance reform proposals. But lines had hardened
and time ran out. Without question, the failure to pass a
comprehensive proposal was the biggest disappointment of the
President's first two years.
VIII.
POSITIVE RESULTS OF THE REFORM EFFORT: MUCH MORE THAN
MEETS THE EYE
Congress may have failed to enact a law, but the reform
effort, when combined with various market forces, has generated an
extraordinary amount of change in the nation's health care delivery
system.
Undoubtedly, some of these changes were occurring prior to the
reform effort and would have gone forward in the absence of that
effort. But the President's proposal --inspite of opponent's
successful efforts to brand it as something it wasn't-- was fully
in tune with market developments, and thus fueled them and
supported them.
Additionally, the highlighting of new ideas, the exposition
of compelling needs, and the focused attention on system failings,
all spurred change and improvement. In the course of reform
effort:
Talk of forming purchasing cooperatives became
commonplace amongst employers and governments.
Employers began demanding lower premiums, and more
information on quality of care and outcomes.
Primary care doctors, specialists, hospitals-- faced with
greater demands for lower costs and greater value, and
sensing the coming of more aggressive competition between
managed care plans-- moved to form more efficient group
practices, and adopt cost-effective managed care
procedures. Health care systems began integrating,
adopting more efficient organizational structures,
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coordinating care across the whole health care spectrum,
and sharing expensive technology wherever possible.
Competition between managed care plans, especially in
some markets, and much as envisioned in the Health
Security Act, reached a new level of maturity. Rates of
growth in premiums declined.
Health plans of all kinds poured resources into
strengthening their ability to provide cost-effective
primary care, and network formation by primary care
physicians accelerated. The result would be greater
emphasis on prevention, and more leadership by primary
care physicians in the medical community.
Insurers came under increased pressure to reduce
administrative costs. Such pressures emerged both from
networks of physicians fighting for higher percentages of
shrinking premiums and from purchasers demanding greater
value.
Rates of growth in pharmaceutical prices fell
substantially, in part, perhaps, due a desire of
manufacturers to thwart the reform drive, but also
because of purchaser pressures, and increasing economies
of scale in purchasing.
And as the reform effort wanted, increasing numbers of
states began seeking Medicaid waivers, hoping to expand
coverage to more individuals by employing cost-effective
managed care principles in Medicaid programs. The
Administration has signalled its clear interest in
encouraging these efforts.
Some might argue that these developments will produce only
minimal change. They may assert that once the threat of reform is
lifted, circumstances will revert to pre-reform conditions and
pre-reform soaring costs.
But such a view misses the fundamental nature of the changes
now occurring. Policy analysts studying integration in health care
markets, the continuing trend to various forms of managed care, and
the increasing pressures from purchasers for lower costs and higher
quality, note that these are developments from which there is no
turning back. Specifically, market changes are going well beyond
discounting, or short term reductions in premiums aimed at
reducing a perception of crisis and undermining reform. They are
focused, among other things, on fundamentally restructuring health
care delivery systems to produce lower costs in a more competitive
marketplace, and on enhancing consumer purchasing power and
consumer information. These are not changes that will be easily
undone, even if some might wish to undo them.
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TEL:
For all these reasons, the Administration's reform effort,
while ending in disappointment, left many positive results and
encouraged many positive and largely irreversible developments.
IX. LOOKING AHEAD: THE ONGOING NEED FOR COMPREHENSIVE REFORM
Still, the need for comprehensive reform remains.
Not all of the trends outlined above are wholly positive.
While they were clearly leading to greater consumer purchasing
power, greater efficiencies in the health care sector, greater
emphasis on prevention, lower costs, and potentially higher
quality there were reasons to be concerned as well.
The movement to managed care, for example, if pushed too
far too fast, could lead to pressures to reduce quality
and service.
Small businesses and families purchasing insurance on
their own still pay more for less, a situation that may
persist and even worsen, as large employers drive
stronger health care bargains, forcing insurers to push
more costs onto smaller, weaker purchasers.
Some of the nation's greatest teaching and research
institutions are experiencing strain in the new
competitive environment. As insurers and managed care
health plans press their providers for lower costs, these
institutions can find that their training costs and the
costs of their mission to care for the uninsured leave
them in weakened competitive posture.
Most importantly, the new market changes are not reducing
the numbers of uninsured Americans. Indeed, those
numbers continue to rise.
And finally, until all are guaranteed the right to
insurance, and the right to keep their insurance at a
fair price, even those with sound insurance will remain
insecure. All will remain at risk of losing insurance --
due to loss of job, a change in job status of oneself or
a spouse, a change in family status, or a serious
illness.
Thus the need for reform must remain near the top of the
national agenda. There is simply too much at stake, and for far
too many.
11
JOB LOCK
Becky and Mike from Merced, California are both locked into jobs because they fear losing
their health insurance. When Becky had twins, one of whom was born with correctible birth
defects, the family was faced with $100,000 in bills, for which even with insurance, they had
to pay $10,000 out of there own pockets. Becky would like to work as a school teacher and
spend more time with her children, but she can not leave her current job because her family
depends on it for their health insurance -- and no other insurance company will agree to cover
their daughter.
SMALL BUSINESS/SELF-EMPLOYED
Dawn Carranzo and her husband, from East Haven, Connecticut, are self-employed small
business owners in the trucking industry. Tha Caranzo's currently have health insurance
because Dawn is a school teacher during the winter and they have coverare through the
school's policy. She would like to stop teaching and expand the trucking business but can not
enlarge their business because they can't afford health insurance for themselves or their
employees. She feels that in order to expand their business and attract skilled employees,
they must be able to provide health insurance for their workers.
Debbie Accuardi owns Accuardi's Old Town Pizza in Portland, Oregon. She and her husband
have between twenty-five and twent-eight part-time employees at any given time. Since 1988
they have offered to pay 50% of the cost of health insurance for their employees.
Unfortunately, at the time, only three employees can afford to buy health insurance through
this policy. Debbie would like to pay 100% of the cost, but can't afford it at this point due to
the size of her business. She feels that if companies are able to offer full health care
coverage, constency and productivity in the work place will increase -- benefitting both the
employee and the customer. This, in turn, will be a financial benefit to the employer.
Debbie owns a small business in an extremely competitive market and finds it difficult to
compete as she provides health insurance to her employees while many of her competitors do
not.
(Were on FLOTUS conference call)
CHILDREN
Collins Wright, from Marvell Arkansas, is a sixth grader with allergies and asthma. In a
letter to the President he wrote, "Have you ever sneezed without a tissue? Well, having
asthma without insurance feels the same." His health problems are so severe that they have
begun to affect his performance in school. Collins' mother is unemployed and his step-father
is self-employed, so they cannot afford health insurance for the family, especially with their
son's pre-existing conditions. There are three children in the family and Mrs. Huff worries
about what will happen to her family if one of them becomes ill.
PRE-EXISTING CONDITION
Marcia and Mark Callendar both had good jobs with good benefits. They thought their
family was well protected by the insurance provided by Mark's employer. Then, their son got
sick, Mark lost his job, and the Callendars lost their insurance. When they tried to apply for
coverage through Marcia's job, they were turned down because of Mathew's "pre-existing
condition." Mathew finally qualified for coverage through disability but Mark had to take a
lower-paying job so that they would be eligible.
INSURANCE ABUSES
Tom and Joan own a small fruit company down in Kensington, Tennesse. For eight years,
Tom paid the health insurance premiums for his employees and his family -- in full and on
time. Then Tom got cancer. After he started treatment the insurance company canceled his
policy. "That block of insurance," the company explained, "was no longer profitable."
RISING COSTS
Kay from Pal Harbor, Florida was forced to go back to work and stop caring for her two
children fill-time when her husband died in 1987. Her health insurance payments rose by
57% -- from $2,400 a year to $3,777. She shopped around for an alternative plan, but the
only one she could afford required that she pay $3,800 befor it would honor a single claim.
She could not afford to pay the premiums, so she dropped insurance for herself and her two
small children.
December 4, 1994
Kim
I attacked this from two angles. First, I tried to find the most visionary quotes which
are at the same time reflective of the political realities we are now dealing with -- no
easy matter! I also however wanted to see if I could find quotes spanning a couple of
years -- from the campaign through the transition to our Administration -- to show Bill
Clinton's commitment to health care was long-standing and strong.
I put in bold the best quotes I found (so you don't need to read all these if time is
tight.) Without knowing exactly what you will propose, I tried to include some specific
quotes [i.e., re prevention, small business, insurance company abuses, etc.] If they have
no relation to our proposal, please ignore them.
I also put parentheses around phrases that I suggest you delete, but I wanted you to
make the final call in light of the whole quote. I put ellipses primarily to tidy up
quotes, although I also got rid of phrases like "And we must do it this year" or
"Without universal coverage..." If I did anything weird to a quote, I indicated it.
However, once you choose the ones you want, you should take a quick look at them in
their original context with an eye to what you know we'll propose.
If there is any particular subject which we are definitely going to address and need a
particular quote on, we can do a more focused search.
Good luck!
Meeghan
CLINTON/GORE'92 CAMPAIGN:
(Might be too workplace oriented) But if our new covenant is really pro-work, it
must mean that people who work shouldn't be poor
At the same time, we must
assure all Americans that they'll have access to health care when they go to work.
That's why so many today maintain themselves on the welfare roles. [Georgetown
University, 10/23/91]
We've got to quit having the federal government try to micro-manage health care
and instead set up incentives for the private sector to manage the cost down
(within limits beyond which we absolutely must not go in spending.) [Campaign
Speech at Merck Pharmaceuticals, 9/24/92]
If we can (cover everybody and) bring costs within inflation, we will save hundreds
of billions of dollars per year by the end of the decade to the private sector -- money
which can then be reinvested in growth, in productivity, in wages, in benefits, in
making America a stronger country. [Campaign Speech at Merck Pharmaceuticals, 9/24/92]
BILL CLINTON HEALTH CARE QUOTES
Page 2
Our infant mortality and low birth weight rates are too high. Our life expectancy,
given our national wealth, is too low. We are not getting the system that we are
paying for and nobody is paying as much as we are for health care. [Campaign Speech
at Merck Pharmaceuticals, 9/24/92]
And I think we have to see [health care] (replaces 'this problem') in the
context of the overall American economic scene. This has to be part of
our efforts to restore growth, improve education, and manage change in a
tough global economy. It's part of a plan to create a high-wage, high-
growth, high-opportunity society in America, to educate and train our
people, to develop new energy policies, new environmental policies, to
promote both personal responsibility and family security. And in that
context, we have to do what we all agree we should do: promote control of
costs, access to health care, and maintain quality. [Campaign Speech at Merck
Pharmaceuticals, 9/24/92]
[Health reform must] (replaces 'It will') preserve what is best about the
present health care system, but it will also incorporate what we have
learned about what is wrong. (My fellow Americans, we are the only
advanced nation in the world that does not provide basic health care to
all its citizens.) We spend 30 percent more of our income than any other
country in the world on health care at a time when we desperately need to
spend more on new plants, new equipment, new businesses, reinvesting in
the education and training of our citizens, and rebuilding our cities and
our depressed rural areas. [Campaign Speech at Merck Pharmaceuticals, 9/24/92]
(Specific cost references. You can use any combination of the following sentences)
Since 1980, the cost increase in American health care has outstripped the rate of
any other country and any previous decade in America Family and individual
spending on health care has tripled in the last decade Elderly people are
spending a bigger percentage of their income on health care today than they were
before Medicare came in. Companies are forced to move jobs overseas because of
health care costs, and people can't change jobs because they or someone in their
family have pre-existing conditions which would preclude them from getting health
insurance if they changed. A recent analysis estimated that 200,000 jobs have
been lost in the last four years because of rising health care costs alone in the
private sector. We are spending 30 percent more of our income than any nation on
earth on health care. And in our hospitals today, clerical employment is growing
at four times the rate of health care giver employment. [Campaign Speech at Merck
Pharmaceuticals, 9/24/92]
BILL CLINTON HEALTH CARE QUOTES
Page 3
PRESIDENTIAL TRANSITION
(Not the best quote but shows commitment. Might better be used in another section
vision/history?)
[A]n animated Clinton, repeatedly pounding his fist on the table, said the amounts
being discussed were small in comparison to the enormity of problems such as
rising health costs. "We are kidding each other. We are all just sitting here making
this up if we think we can fiddle around with entitlements and all this other stuff
and get control of this budget if we don't do something on health care. It (health
care spending) is a joke. It is going to bankrupt this country." [Chicago Tribune,
December 15, 1992]
ADMINISTRATION:
Announcement of President's Task Force on National Health Reform:
As I traveled across the country last year, no stories moved me more than the
health care stories
We've met elderly people choosing every week between
medicine and food; we've met people forced to leave their jobs to get on public
assistance to deal with children with terrific problems; we've met countless people
who can't change their jobs because they or someone in their family have had
health care problems. [Announcing President's Task Force on National Health Reform,
1/25/93]
The message is pretty simple. It's time to make sense of America's health care
system. It's time to bring costs under control and to make our families and
businesses secure. It's time to make good on the American promise that too many
people have talked about for too long, while we have continued to spend more than
30 percent more of our income on health care than any other nation in the world,
get less for it, and see 100,000 Americans a month losing their health insurance.
[Announcing President's Task Force on National Health Reform, 1/25/93]
But as I said in my Inaugural Address, we're going to have to make some tough
choices in order to control health care costs, to bring them down within inflation,
and to provide health care for all (problem?). In order to preserve the vitality of the
American private sector, in order to keep the American people's budget here at this
national level from going totally bankrupt, we are going to have to make some
tough choices. [Announcing President's Task Force on National Health Reform, 1/25/93]
Number one, the worst thing we can do is keep on doing what we're doing now,
because more and more people are falling out of the system and the cost is
becoming more and more burdensome to those who are still bearing it. So
whatever course we take, we will preserve what is best about American health
care, some consumer choice and the quality of care. [Announcing President's Task Force
on National Health Reform, 1/25/93]
BILL CLINTON HEALTH CARE QUOTES
Page 4
First Joint Session Speech
Our families will never be secure, our businesses will never be strong, and
our government will never again be fully solvent until we tackle the
health-care crisis. [Joint Session of Congress, 2/17/93]
The combination of the rising cost of care and the lack of care and the
fear of losing care are endangering the security and the very lives of
millions of our people and they are weakening our economy every day.
Reducing health care costs can liberate literally hundreds of billions of
dollars for new investment in growth and jobs. [Joint Session of Congress,
2/17/93]
Bringing health costs in line with inflation would do more for the private
sector in this country than any tax cut we could give and any spending
program we could promote. Reforming health care over the long run is
critically essential to reducing not only our deficit but to expanding
investment in America. [Joint Session of Congress, 2/17/93]
(I would use entire first quote combined with this one, and perhaps last sentence of
second one.)
Joint Session Speech to Congress on Health Care
Despite the dedication of literally millions of talented health care professionals, our
health care is too uncertain and too expensive, too bureaucratic and too wasteful.
It has too much fraud and too much greed. [Joint Session Speech to Congress on Health
Care, September 22, 1993]
We're blessed with the best health care professionals on Earth, the finest
health care institutions, the best medical research, the most sophisticated
technology.
We have to preserve and strengthen what is right with the
health care system, but we have got to fix what is wrong with it
Every
one of us knows someone who's worked hard and played by the rules and
still been hurt by this system that just doesn't work for too many people.
[Joint Session Speech to Congress on Health Care, September 22, 1993] (Note: I inverted
these three sentences (3,2,1) to make the best quote.)
(If prevention will be a theme) Now, it's just common sense. We know, any family
doctor will tell you, that people will stay healthier and long-term costs of the health
system will be lower if we have comprehensive preventive services. You know how
all of our mothers told us that an ounce of prevention was worth a pound of cure?
Our mothers were right. And it's a lesson, like so many lessons from our mothers,
that we have waited too long to live by. It is time to start doing it. [Joint Session
Speech to Congress on Health Care, September 22, 1993]
BILL CLINTON HEALTH CARE QUOTES
Page 5
Rampant medical inflation is eating away at our wages, our savings, our
investment capital, our ability to create new jobs in the private sector,
and this public Treasury. We cannot continue to do this. Our
competitiveness, our whole economy, the integrity of the way the
Government works, and ultimately, our living standards depend upon our
ability to achieve savings without harming the quality of health care.
[Joint Session Speech to Congress on Health Care, September 22, 1993]
People may disagree over the best way to fix this system. We may all
disagree about how quickly we can do the thing that we have to do. But
we cannot disagree that we can find tens of billions of dollars in savings
in what is clearly the most costly and the most bureaucratic system in the
entire world. And we have to do something about that, (and we have to do
it now.) [Joint Session Speech to Congress on Health Care, September 22, 1993]
But let me say this - and I hope every American will listen, because this is
not an easy thing to hear - responsibility in our health care system isn't
just about them. It's about you. It's about me. It's about each of us. Too
many of us have not taken responsibility for our own health care and for
our own relations to the health care system. [Joint Session Speech to Congress
on Health Care, September 22, 1993]
(Long but visionary) (And now it is our turn to strike a blow for freedom in this
country, the freedom of Americans to live without fear that their own nation's
health care system won't be there for them when they need it.) It's hard to believe
that there was once a time in this century when that kind of fear gripped old age,
when retirement was nearly synonymous with poverty and older Americans died in
the street. That's unthinkable today, because over a half a century ago Americans
had the courage to change, to create a Social Security System that ensures that no
Americans will be forgotten in their later years. Forty years from now, our
grandchildren will also find it unthinkable that there was a time in this country
when hardworking families lost their homes, their savings, their businesses, lost
everything simply because their children got sick or because they had to change
jobs. Our grandchildren will find such things unthinkable tomorrow if we have the
courage to change today
And when our work is done, we will know that we
have answered the call of history and met the challenge of our time. [Joint Session
Speech to Congress on Health Care, September 22, 1993]
Transmittal of Legislation to Congress -- Speech at Statuary Hall:
And let me say again: the most expensive thing we can do is nothing. The
present system we have is the most complex, the most bureaucratic, the
most mind-boggling system imposed on any people on the face of the
earth. The present system we have has the highest rate of inflation with
the lowest rate of return. [Transmittal to Congress, 10/26?/93]
BILL CLINTON HEALTH CARE QUOTES
Page 6
(Probably too strong) The present system we have has an indefinable impact on
workers in the workplace wondering what will happen if they lose their health
insurance. What does that do to their productivity, to their self-confidence, to their
family life?
The present system we have is eating up the wage increases that
would otherwise flow to millions of American workers every year because money
has to go to pay more for the same health care. [Transmittal to Congress, 10/26?/93]
[Without health care reform] (replaces 'And the most important thing is')
we can't give the American people what they need. They want to be
rewarded for their work. They want to know if they're asked to go back to
school, if they're asked to embrace the challenges of expanded trade, if
they're asked to compete and win in the global marketplace, that - if they
do what they're supposed to do - they'll be rewarded. They want to know
that they can be good parents and good workers. They want to know if
they get sick, but they're still healthy enough to work, they won't have to
quit because of the insurance system.
That's what we got hired to do -
to solve the problems of the people and to take this country into the 21st
century. [Transmittal to Congress, 10/26?/93]
Transmittal of Legislation to Congress Letter to Congressional Leaders:
Today, America boasts the world's best health care professionals, the
finest medical schools and hospitals, the most advanced research and the
most sophisticated technology. No other health care system in the world
exceeds ours in the level of scientific knowledge, skill and technical
resources.
And yet the American health care system is badly broken. Its
hallmarks are insecurity and dangerously rising costs.
Clearly,
our
challenges are great.
to preserve and strengthen what is right about our
health care system, and fix what is wrong. [Letter to Congress, 10/27/93]
(If helping small businesses will be a theme.) Small businesses create most of the
new jobs in America and while most want to cover their employees, more and more
cannot. Under the current health care system, cost pressures are forcing a growing
number of small business owners to scale back or drop health insurance for their
employees. Small businesses spend 40 cents of every health insurance dollar for
administration eight times as much as large companies. [Letter to Congress, 10/27/93]
(Prevention) Our health care system frustrates those who deliver care
Its
incentives are upside down; it focuses on treating people only after they get sick,
and does not reward prevention. [Letter to Congress, 10/27/93]
BILL CLINTON HEALTH CARE QUOTES
Page 7
1994 State of the Union
But we're paying more and more money for less and less care. Every year
fewer and fewer Americans even get to choose their doctors. Every year
doctors and nurses spend more time on paperwork and less time with
patients because of the absolute bureaucratic nightmare the present
system has become. This system is riddled with inefficiency, with abuse,
with fraud, and everybody knows it. In today's health care system,
insurance companies call the shots. They pick whom they cover and how
they cover them. They can cut off your benefits when you need your
coverage the most. They are in charge.
If we just let the health care
system continue to drift, our country will have people with less care,
fewer choices, and higher bills. [State of Union, 1/24/94]
(Is this still a theme?) It is estimated that one million people are on welfare today
because it's the only way they can get health care coverage for their children.
Those who choose to leave welfare for jobs without health benefits, and many
entry-level jobs don't have health benefits, find themselves in the incredible
position of paying taxes that help to pay for health care coverage for those who
made the other choice to stay on welfare. No wonder people leave work and go
back to welfare to get health care coverage. (We've got to solve the health care
problem to have real welfare reform.) [State of Union, 1/24/94]
(If we emphasize prevention) [W]e all have to admit, too, there must be more
responsibility on the part of all of us in how we use this system. People have to
take their kids to get immunized. We should all take advantage of preventive care.
We must all work together to stop the violence that explodes our emergency rooms.
We have to practice better health habits, and we can't abuse the system. [State of
Union, 1/24/94]
Small Business Roundtable
Now, we have the best doctors, the best nurses, the best health care providers, the
best medical research, the best medical technology in the world. And we also have
by far the most bureaucratic and administratively costly health care system in the
world. There's more paperwork in our system today and it costs more to
administer this system by far than any other system in the world. [Small Business
Roundtable, 4/7/94]
BILL CLINTON HEALTH CARE QUOTES
Page 8
(If insurance abuses are a theme. Pick and choose from which ones you'll fix!)
Eighty-one million of us, more than one in four, live in families where somebody as
had a preexisting condition -- a child with diabetes, a father with a heart attack, a
mother who has had cancer -- and we either pay higher rates or we can't get health
insurance, or we've got a job with health insurance but we can never change jobs
because if we change jobs nobody will insure us because someone in our family has
been sick. A hundred and thirty-three million of us, a majority, are insured with
lifetime limits, so if, God forbid, we should have a child with a pronounced and
prolonged chronic problem, we could run out of health care coverage just when we
need it most. None of these conditions exist in the countries with which we are
competing for the economic opportunities of the 21st century. [Small Business
Roundtable, 4/7/94]
also: Tom Mereditz
PRESIDENTIAL REMARKS:
Kingston, TN
ANECDOTES ON HEALTH CARE, 1993-4
Remarks at a Health Care Rally in Jersey City, New Jersey, August 1, 1994
You know, I hear a lot of talk to day about what constitutes real patriotism,
what constitutes being a real American, characterizations of what we're trying
to do with health care. I think Carolyn is a real American, and what is their
answer to her? Just before I came over here I met the Agneses. He's a barber.
He told me how much his health care had gone up and that his business might go
down. What is the chanters' answer to him? Just before I came over here I met
a woman named Jean McCabe, whose health insurance premiums got almost up to $
10,000. And she wrote us a letter and said, "Am I going to have to move to
Canada or Germany or someplace where I can find somebody who will treat me like
a decent citizen?" What is their answer to her? I met Michael and Joanne Britt.
He's a truck driver; she's been sick. Their insurance cost them so much, they
were living in a house trailer, and they thought they would never be able to buy
a home, never set aside any money for retirement because they couldn't afford
their health care, in this, a country that's supposed to be a middle class
country that rewards work and family and faith and playing by the rules. What
is their answer to her?
Remarks and a Question-and-Answer Session With the National Governors'
Association in Boston, Massachusetts, July 19, 1994
Now, how are we going to provide that kind of security? And let me say there
is a human face behind this. I don't want class warfare, but let's look at the
facts. Over 80 percent of all the people without insurance in America are
A
people who work for a living; they're working people. This morning I had coffee
with a man named Jim Bryant and his wife, Mary, and their two children because I
read about him in the Boston Globe. He works 60 hours a week and doesn't have
any health insurance. And they talked about how much they worked and said they
had a good life and all the extra money they had they were putting away for
their kids' college education, but they would be ruined if they ever had an
illness.
And I asked him if he could afford to pay something, and he said, "Sure." I
said, "Would you like to know how much I pay a month for health care as the
President of the United States, or Members of Congress or members of the Federal
Government?" He said, "Yes." I said, "We pay about $ 100 a month, and our
employer, you, pays $ 300 a month. And he said, "I could pay that easy." He
said, "I could pay twice that."
I was in western Pennsylvania, Governor Casey's State. And by the way, I
appreciate your support for reform and your attempt to resolve the abortion
issue, Governor Casey. But I was in western Pennsylvania, Greensburg,
Pennsylvania; two women got up and spoke before me. I don't know if they were
Republicans or Democrats, don't have any idea who they voted for. One of them
was a dairy farmer, 62 years old. And you know, that's about the hardest
farming there is. You've got to work 7 days a week because you can't tell the
cows to quit producing milk. Sixty-two years old, they finally had to give up
health care at the time she needed it most, this woman did, she and her husband,
because they just couldn't afford it anymore.
And then, after that, a woman spoke who was a mother of five children, and
she introduced her husband. She had had cancer, and he had had to change jobs
and didn't have health insurance. And there are lots of people out there like
that. We're talking millions of people, not just a few. And the issue is not
just them but it's everybody else that could be in that position.
Remarks to the American Nurses Association Conference, May 10, 1994
Had a car dealer from a town of 7,000 people in Arkansas up staying with me
the other night, he and his wife, long-time friends of mine. She's a college
teacher. He's a car dealer. He said to me the other night -- it was funny --
he said, "You know, for 20 years I have been feeling sorry for myself because
I've provided a good health plan for my employees, and none of my competitors
did." So he said, "I was so happy when you proposed this just because I thought
I was going to get even." [Laughter] And then he said, "But you know, then I
remembered that in the last 20 years I put three of my competitors out of
business. And I'm making more money than I ever have. And the reason is I
still got the same folks working for me I had 20 years ago because I gave them
health benefits."
And yesterday I went to New York and I visited this Pathmark store. They
have 175 stores, 28,000 employees, the 10th biggest supermarket chain in the
country. We're all told, "Oh, if you do this, the retailing business will go to
pieces." These people have put new stores in inner-city areas that other chains
would not touch, fine new stores. They are making money, and they have always
provided comprehensive health benefits to their employees. And they are now
sacking their groceries in a bag that says they favor health care benefits to
all Americans, guaranteed through the workplace.
Teleconference With the California Medical Association, March 23, 1994
I have a doctor friend who calls me about every 3 months to tell me another
horror story. Recently he told me, "We've got all these people doing paperwork.
Now we've hired somebody who doesn't even fill out forms, just spends all day on
the telephone beating up on the insurance companies about the forms we've
already sent in." He's told me, he said, "I went to medical school to practice
medicine, but I'm getting lost in the fun house instead." Well, he's right, and
I know a lot of you agree with him and identify with that story. But this year
we can escape that fun house.
Remarks to Health Care Providers, March 23, 1994
Just this week, to give you another personal story, Hillary and I had a
family staying with us here from our home State, a man who is in the car
business, has been for 20 years. He said, "You know, I've always hought about
what a competitive disadvantage I face because I've always covered all my
employees in my automobile place, and none of my competitors ever had. And I
just moaned about it all the time. And then I realized, I'm in business after
20 years and doing better than I ever have and three of my competitors have gone
broke even though they didn't cover their employees, and I did. And it's
because I've still got the same people working for me that started with me 20
years ago taking care of our customers, doing a good job, providing quality
service and a good product."
Remarks to the National Governors' Association, February 1, 1994
On the way in, I was describing briefly to Governor Campbell a
letter I got from -- -or she got from Jo Anne Osteen of Sumter, South Carolina,
who owns a small business, works 6 days a week, raised three children by herself
with diabetes and arthritis. Although she had diabetes and arthritis, when she
wrote us she hadn't been in the hospital one time in the 12 years that she'd
been with her insurers. But her insurance rates went up to $ 306 a month, even
though she was only taking home $ 205 a week from her business. Her doctors
told her that the answer was to quit and go on disability. So she wrote, "Those
high premiums are going to force people like me to the welfare and food stamp
lines with no insurance. I am a proud American, and I don't want this to happen
to me. I have thought about nothing but this problem, and I don't know where to
turn."
Well, I think we ought to heed her call for help. A lot of you do, too, and
that's why you've tried to reform your health care systems. After all, this
woman has values that keep this country together. They're the ones that built
our Nation. And we shouldn't force people like that to consider seriously
whether they should go on to public assistance in order to take care of their
children
I talked to you a few moments ago about Jo Anne Osteen from Sumter, South
Carolina. She wrote us last June, struggling to hang on to both her small
business and her insurance. She had to make a choice, and she chose her
business and lost her coverage. After decades and decades, it's time to solve
that woman's problem, because her problem is our problem. And her problem is
now the State government's problem.
Address Before a Joint Session of the Congress on the State of the
Union, January 25, 1994
You know, the First Lady has received now almost a million letters from
people all across America and from all walks of life. I'd like to share just
one of them with you. Richard Anderson of Reno, Nevada, lost his job and with
it, his health insurance. Two weeks later his wife, Judy, suffered a cerebral
aneurysm. He rushed her to the hospital, where she stayed in intensive care for
21 days. The Andersons' bills were over $ 120,000. Although Judy recovered and
Richard went back to work at $ 8 an hour, the bills were too much for them, and
they were literally forced into bankruptcy. "Mrs. Clinton," he wrote to
Hillary, "no one in the United States of America should have to lose everything
they've worked for all their lives because they were unfortunate enough to
become ill." It was to help the Richard and Judy Andersons of America that the
First Lady and so many others have worked so hard and so long on this health
care reform issue. We owe them our thanks and our action.
Address to a Joint Session of the Congress on Health Care Reform, September 22, 1993
Every one of us knows someone who's worked hard and played by the rules and
still been hurt by this system that just doesn't work for too many people. But
I'd like to tell you about just one. Kerry Kennedy owns a small furniture store
that employs seven people in Titusville, Florida. Like most small business
owners, he's poured his heart and soul, his sweat and blood into that business
for years. But over the last several years, again like most small business
owners, he's seen his health care premiums skyrocket, even in years when no
claims were made. And last year, he painfully discovered he could no longer
afford to provide coverage for all his workers because his insurance company
told him that two of his workers had become high risks because of their advanced
age. The problem was that those two people were his mother and father, the
people who founded the business and still work in the store.
This story speaks for millions of others. And from them we have learned a
powerful truth. We have to preserve and strengthen what is right with the
health care system, but we have got to fix what is wrong with it.
Just a few days ago, the Vice President and I had the honor of visiting the
Children's Hospital here in Washington where they do wonderful, often miraculous
things for very sick children. A nurse named Debbie Freiberg told us that she
was in the cancer and bone marrow unit. The other day a little boy asked her
just to stay at his side during his chemotherapy. And she had to walk away from
that child because she had been instructed to go to yet another class to learn
how to fill out another form for something that didn't have a lick to do with
the health care of the children she was helping. That is wrong, and we can stop
it, and we ought to do it.
We met a very compelling doctor named Lillian Beard, a pediatrician, who said
that she didn't get into her profession to spend hours and hours -- some doctors
up to 25 hours a week -- just filling out forms. She told us she became a
doctor to keep children well and to help save those who got sick. We can
relieve people like her of this burden. We learned, the Vice President and I
did, that in the Washington Children's Hospital alone, the administrators told
us they spend $ 2 million a year in one hospital filling out forms that have
nothing whatever to do with keeping up with the treatment of the patients.
I ask you to remember the kind of people I met over the last year and a half:
the elderly couple in New Hampshire that broke down and cried because of their
shame at having an empty refrigerator to pay for their drugs; a woman who lost a
$ 50,000 job that she used to support her six children because her youngest
child was so ill that she couldn't keep health insurance, and the only way to
get care for the child was to get public assistance; a young couple that had a
sick child and could only get insurance from one of the parents' employers that
was a nonprofit corporation with 20 employees, and so they had to face the
question of whether to let this poor person with a sick child go or raise the
premiums of every employee in the firm by $ 200; and on and on and on.
I know we have differences of opinion, but we are here tonight in a spirit
that is animated by the problems of those people and by the sheer knowledge that
if we can look into our heart, we will not be able to say that the greatest
nation in the history of the world is powerless to confront this crisis.
Remarks at the Congressional Black Caucus Dinner, September 18, 1993
And I went to the Children's Hospital in this city this week and heard a
nurse say that she had to turn away from a child with cancer who wanted her to
play with him because she had to go to a school to learn how to fill out yet
another new form in the most insane bureaucratic maze of financing that any
country on the face of the Earth has. I heard a doctor plead with me -- you may
have seen her on television -- a pediatrician, a native of this city, plead with
me to do something to lift the burden of the present health care financing and
regulatory system off her back. The Washington Children's Hospital said that
the 200 doctors that have privileges at that hospital could see another 500
children a year each, 10,000 more children, if we just had the courage to make
the simple changes in our health care system that other nations have already
made. I tell you, we can do better, and we must. And we must do it together.
Remarks at the New Hampshire Technical College Commencement Ceremony
in Stratham, New Hampshire, May 22, 1993
I'll never forget people like Ron Macos, Jr., who couldn't get a job
with health insurance because his little boy, had open heart surgery. And when
the Fixst Lady's health care task force presents the national health ere
proposal in the next few weeks to the Congress, if that proposal passes, the Ron
Macoses of this world will be able to keep working and raising their children in
the future.
Remarks at a Reception for the President's Health Care Task Force, April 29, 1993
I wish I could write a book. I wish I could even remember all the incredible
stories I heard along this last year and a half when we were out on the campaign
trail, related to health care.
I'll never forget the woman I met in Columbus, Ohio who had six or seven kids
and had to give up a $ 50,000 a year job because one of her children was so
sick, and the only way she could get any care was to become Medicaid eligible;
the farmers that I met along the way who couldn't get health insurance, or if
they did, it took up the whole profit from the farms in the average years; the
small-business person I met who had only four employees and was chagrined
because of the exploding cost of insurance in his small group, he had to go to a
$ 2,500 deductible, and how badly he felt for his own employees; the big
businesses that told me about their inability to compete in a global economy
because they had to spot their competitors so much; the doctors that I know who
wanted to be good doctors and wanted to reach out to people who were spending
more and more of their time and money on paperwork and regulation, and on and on
and on.
Remarks on Health Care Reform and an Exchange With Reporters, January 25, 1993
As I traveled across the country last year, no stories moved me more than the
health care stories. As I think all of you know, many of the people in our
Faces of Hope luncheon last week during the Inaugural were people who were
struggling to overcome incredible adversity occasioned by their health care
problems. We've met elderly people choosing every week between medicine and
food; we've met people forced to leave their jobs to get on public assistance to
deal with children with terrific problems; we've met countless people who can't
change their jobs because they or someone in their family have had health care
problems.